Position Overview:
We are seeking a proactive and detail-oriented individual to be a hands-on Prior Authorization (PA) processor and the primary point of contact for managing our outsourced vendor relationships. This role contributes directly to the completion of PA workflows while overseeing the training, quality assurance, and performance support of our outsourced PA workforce. The ideal candidate will be a Subject Matter Expert (SME) in PA processing with strong operational awareness and communication skills to ensure alignment between internal expectations and external execution.
This role also requires a level of technical fluency: the ability to work alongside developers, data scientists, and product owners to continuously improve tooling, workflows, and automation. Candidates should be comfortable speaking the “language” of both healthcare operations and technology, and able to apply excel formulas, querying, or automation tools to improve the efficiency of their own tasks and the broader PA process.

• Complete Prior Authorization submissions, status checks, and resolution activities using specific systems and payer portals.
• Ensure accuracy, timeliness, and completeness of all PA tasks assigned.
• Adhere to HIPAA, compliance, and client confidentiality guidelines at all times.
• Participate in process testing or pilot workflows when needed to support operational initiatives.