Prior Authorization Specialist

A company is looking for a Prior Authorization Specialist.

Key Responsibilities

Act as the internal expert on prior authorization workflows and payer requirements

Collaborate with product teams to design and validate new product features focused on clinical intelligence

Review and organize real-world prior authorization data to support model training and evaluation

Required Qualifications

RN or other clinical background required

5+ years of experience managing medical prior authorizations in a large health system

Deep understanding of medical necessity documentation and payer-specific criteria

Experience submitting and managing outpatient prior authorizations across various procedures

Familiarity with EMRs and payer portals