Prior Authorization Specialist

DrFirst; France; A distancia; EUR 45.000 - 53.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Performance-based bonus

Medical, dental, and vision insurance

401K with company match

HSA contribution

Descripción de la vacante

DrFirst is seeking a remote Prior Authorization Specialist to research, interpret, and maintain payer-specific PA requirements. You will work with developers and data scientists to improve tooling, workflows and automation across PA processes.

Ideal candidates have 3+ years in PA processing, strong knowledge of payer policies, excellent communication, and comfort with scripting and structured logic. This is a remote, U.S.-based role with flexible hours and collaboration across teams.

Formación

• 3+ years of hands-on experience in prior authorization processing or healthcare operations.
• Strong knowledge of payer policies, benefits, and PA workflow structures.
• Experience working with payer portals, benefit lookup tools, and medical policy documentation.
• Excellent communication and documentation skills; able to interface with technical and non-technical stakeholders.
• Comfortable working with structured logic, configuration tools, and basic scripting/querying to automate or optimize workflows.
• Highly organized, detail-oriented, and able to manage multiple tasks in a remote, fast-paced setting.
• Experience supporting automation or working with structured logic/rules-based tools is a plus.

Responsabilidades

• Research and interpret prior authorization rules and payer-specific requirements across service types and benefit types.
• Use internal tools to enter unformatted payer guidelines into a standardized configuration format used by the DrFirst platform.
• Keep payer documentation and configuration records up to date when prior authorization requirements change.
• Collaborate cross-functionally with software development, product, and data science teams to suggest process improvements, validate enhancements, and test new automation or UI changes.
• Identify opportunities to streamline tasks automation-enabling tools.
• Interface with payers and vendors to clarify, confirm, and update contractual PA requirements.
• Ensure PA configuration accuracy, completeness, and timely execution in support of client expectations and automation initiatives.
• Participate in testing of new workflows, pilot projects, or tools related to PA processing.
• Adhere to HIPAA, compliance, and internal data security standards.
• Perform other tasks and support initiatives as assigned.

Conocimientos

PA workflows

Payer policies

Payer portals

Communication skills

Structured logic

Automation tools

Remote work

Detail oriented

Herramientas

Payer portals

Benefit lookup tools

Medical policy documentation

Descripción del empleo

About DrFirst

For 25 years, DrFirst has empowered providers and patients to achieve better health through intelligent medication management. We improve healthcare workflows and help patients start and stay on therapy with end-to-end solutions that enhance prescription access, affordability, and adherence. Our solutions help 100 million patients a year and are used by more than 420,000 prescribers, 71,000 pharmacies, 270 EHRs and health information systems, and over 2,000 hospitals in the U.S. This is a great opportunity to be a part of a successful Healthcare IT company experiencing significant growth. Here you'll get to work with some of the smartest and most interesting people around; solving unique and complex challenges in healthcare on a scale matched by a few companies. If you get excited about stretching yourself in new ways, developing yourself to your fullest potential, care about working with smart colleagues; we want to talk to you!

Position Overview

The Prior Authorization Specialist is responsible for researching, interpreting, and maintaining accurate prior authorization (PA) requirements for a variety of insurance payers. This role combines regulatory and operational knowledge with attention to detail and collaboration across internal teams to ensure the integrity of DrFirst’s rules engine and operational tools. The ideal candidate is experienced in PA workflows, highly organized, and comfortable parsing payer documentation into standardized internal formats.

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.

What you will work on

• Research and interpret prior authorization rules and payer-specific requirements across service types and benefit types.

• Use internal tools to enter unformatted payer guidelines into a standardized configuration format used by the DrFirst platform.

• Keep payer documentation and configuration records up to date when prior authorization requirements change.

• Collaborate cross-functionally with software development, product, and data science teams to suggest process improvements, validate enhancements, and test new automation or UI changes.

• Identify opportunities to streamline tasks automation-enabling tools.

• Interface with payers and vendors to clarify, confirm, and update contractual PA requirements.

• Ensure PA configuration accuracy, completeness, and timely execution in support of client expectations and automation initiatives.

• Participate in testing of new workflows, pilot projects, or tools related to PA processing.

• Adhere to HIPAA, compliance, and internal data security standards.

• Perform other tasks and support initiatives as assigned.

Qualifications

• 3+ years of hands-on experience in prior authorization processing or healthcare operations.

• Strong knowledge of payer policies, benefits, and PA workflow structures.

• Experience working with payer portals, benefit lookup tools, and medical policy documentation.

• Excellent communication and documentation skills; able to interface with technical and non-technical stakeholders.

• Comfortable working with structured logic, configuration tools, and basic scripting/querying to automate or optimize workflows.

• Highly organized, detail-oriented, and able to manage multiple tasks in a remote, fast-paced setting.

• Experience supporting automation or working with structured logic/rules-based tools is a plus.

Physical Requirements

• Remote (U.S.-based)
• Full-time role during standard business hours, with occasional flexibility based on project needs

Benefits

• Competitive compensation, with a base salary of $50,000-$59,000 (Exact compensation may vary based on skills and experience)
• Eligible for Company Performance-based Bonus Program, based on individual and company performance
• Medical, dental, and vision insurance
• 401K eligible after 3 months of employment, with 50% company match up to first 5% of salary contributed to the plan with a 3-year vesting schedule
• HSA for eligible employees enrolled in the HDHP, with a generous company contribution up to $500 for individual coverage and $1000 for family coverage per year
• 100% company paid short and long-term disability, AD&D, and group life insurance
• Accrued annual paid time off (PTO) of 18 days for the first 3 years of service, increasing thereafter and 7 paid holiday days
• Employee Assistance Program
• Continuing Education funds up to $1500 annually for eligible programs after 1 year of service
• Voluntary benefits including FSA, Hospital indemnity, Accident and Critical Illness insurances

DrFirst is committed to being a Remote-First company, creating a dynamic and flexible workplace where everyone can thrive, no matter where they log in from. Check out our approach to remote workhttps://drfirst.com/company/about-us/careers/.

Learn more about our benefits and professional development opportunitieshttps://drfirst.com/company/about-us/careers/the-perks/.