Authorization Specialists - Healthcare Insurance

Solum Health (YC 22); Colombia; Remote; COP 127,409,000 - 222,965,000; Full time

Job summary

Solum Health (YC 22) is seeking a detail-driven Prior Authorization Specialist to join a remote Colombia-based team. You will build and submit authorization requests for U.S. facilities, track approvals, and ensure every submission is complete and timely to keep services moving.

The role requires hands-on experience with EHR systems and payer portals, bilingual English, and the discipline to manage high-volume authorizations, re-authorizations, and appeals. You’ll work U.S.

Qualifications

• 2–3 years managing prior authorizations for U.S. facilities (required).
• Experience in outpatient settings (speech therapy, occupational therapy, ABA, imaging or behavioral health).
• Hands-on experience with EHR systems (required).
• Direct experience working with U.S.-based companies and familiarity with the U.S. healthcare system (required).

Responsibilities

• Obtain authorizations end to end. Build and submit prior authorization requests, track them through the payer, follow up persistently, and confirm approval before services are delivered.
• Get the clinical story right. Gather and review the documentation payers require — clinical notes, CPT/ICD codes, medical necessity — and make sure each submission is complete and accurate the first time.
• Manage the full lifecycle. Track authorization status, expiration dates, units, and re-authorizations so nothing lapses and no care is delivered without coverage in place.
• Fight denials. Identify why requests are denied, prepare and submit appeals, and coordinate peer-to-peer reviews to overturn them.
• Own quality and outcomes. Review your own and the team's authorizations for accuracy, catch problems before they become denials or delays, and make sure approval-rate and turnaround targets are consistently met.
• Keep the EHR accurate. Enter and maintain authorization and patient information with precision. Current, error-free records are non-negotiable.
• Track and report. Use Excel (including pivot tables) to monitor authorization volume, approval rates, turnaround, and denials, and surface where things are slipping.

Skills

Bilingual English

Detail-oriented

Strong communication

High-volume work

Education

Bachelor's degree or Associate degree in healthcare administration

Tools

EHR systems

Availity

Payer/insurance portals

Job description

Remote (Colombia) · U.S. Time Zones · Outpatient Healthcare

Why this role exists

For most outpatient care in the U.S., nothing happens until the payer says yes. A clean, complete prior authorization is the difference between a patient starting therapy this week and waiting a month — and between a clinic getting paid and eating a denial. It's detailed, deadline-driven work, and when it's done well, families never even know how much went on behind the scenes.

What you'll do

• Obtain authorizations end to end. Build and submit prior authorization requests, track them through the payer, follow up persistently, and confirm approval before services are delivered.
• Get the clinical story right. Gather and review the documentation payers require — clinical notes, CPT/ICD codes, medical necessity — and make sure each submission is complete and accurate the first time.
• Manage the full lifecycle. Track authorization status, expiration dates, units, and re-authorizations so nothing lapses and no care is delivered without coverage in place.
• Fight denials. Identify why requests are denied, prepare and submit appeals, and coordinate peer-to-peer reviews to overturn them.
• Own quality and outcomes. Review your own and the team's authorizations for accuracy, catch problems before they become denials or delays, and make sure approval-rate and turnaround targets are consistently met. You're the checkpoint that keeps the work clean.
• Keep the EHR accurate. Enter and maintain authorization and patient information with precision. Current, error-free records are non-negotiable.
• Track and report. Use Excel (including pivot tables) to monitor authorization volume, approval rates, turnaround, and denials, and surface where things are slipping.

What we're looking for

Experience

• 2–3 years managing prior authorizations for U.S. facilities (required). This is the core of the role, not a side skill — you should have owned the full authorization-to-appeal process at volume.
• Experience in a similar outpatient setting — speech therapy (ST), occupational therapy (OT), ABA, imaging or behavioral health.
• Hands-on experience with EHR systems (required).
• Direct experience working with U.S.-based companies and familiarity with the U.S. healthcare system (required).

Insurance know-how

Strong grasp of insurance procedures and terminology — CPT codes, ICD, SCA, medical necessity criteria — including authorizations, re-authorizations, denials, and appeals.

Quality mindset

• Track record of catching errors and ensuring accuracy in a high-volume environment; comfortable being accountable for outcomes, not just task completion.
• Hands-on experience with Availity, and payer/insurance portals for submitting and follow ups.

Language

• Fully bilingual, with English at a minimum B2 or C1 level.

Education

• Bachelor's degree preferred; Associate's degree considered. Substantial equivalent experience in healthcare administration also considered.

Who thrives here

• Detail-obsessed and highly organized, with the ability to juggle many moving pieces without dropping any.
• Takes ownership of outcomes and quality, not just the checklist.
• Persistent and unflappable when chasing payers and fighting denials.
• A strong, warm communicator who genuinely wants to help families get to care.
• Comfortable working independently and as part of a team in a fast-paced, tech-driven environment.
• Steady under pressure and able to hit tight deadlines.

The fine print

This is a remote role for a Colombia-based candidate working directly with some of the largest healthcare providers in the U.S. You'll work U.S. time zones and follow the U.S. holiday calendar.

We're not hiring for a 9-to-5. We're hiring someone who's curious, learns fast, and is excited to grow into a successful career while taking on new challenges along the way.