Prior Authorization Specialist

About the role

We're hiring an experienced Prior Authorization Specialist to help build the future of authorization automation for home health and hospice. Prior authorization is one of the largest operational bottlenecks for agencies. Our platform automatically verifies benefits, gathers documentation, submits authorizations, follows up with payers, and monitors approval status.

Key responsibilities

• Audit authorization workflows, reviewing completed requests for completeness, accuracy, and turnaround time, and identifying recurring failure points.
• Partner with product and engineering teams to translate complex payer rules into scalable automation workflows, defining escalation logic, documentation requirements, and exception handling.
• Create and maintain SOPs and payer playbooks covering Medicare Advantage, Medicaid, managed Medicaid, commercial payers, and state‑specific requirements.
• Collaborate with client intake, authorization, and billing teams to resolve escalations and configure automation to match operational needs.
• Monitor operational performance metrics such as turnaround times, approval rates, denial trends, and automation success, driving continuous improvement initiatives.

Required profile

• 3+ years of prior authorization experience within home health, hospice, or post‑acute care.
• Deep familiarity with Medicare Advantage, Medicaid, managed Medicaid, commercial insurance, and authorization workflows.
• Experience obtaining authorizations across multiple payer portals and strong understanding of eligibility verification and documentation requirements.
• Strong organizational skills with excellent attention to detail and ability to work independently in a fast‑moving startup.
• Nice to have RN, LPN, or clinical background.

Required skills

• HomeCare HomeBase (HCHB)
• Axxess
• WellSky
• KanTime
• Careport
• Forcura
• Ensocare
• Experience with automation or RCM software platforms