AI-Quality PA Specialist: Product & Workflow Validation

Deliverhealth Solutions; United States; Remote; USD 90,000 - 130,000; Full time

Job summary

DeliverHealth Solutions is seeking an experienced Prior Authorization Specialist to support InstaAuth, our AI-powered PA platform. You will evaluate AI-driven workflows, validate clinical documentation, and ensure payer requirements are met, bridging clinical and product teams to improve automation and reliability.

This role emphasizes product quality and clinical AI, not direct submission of authorizations, and requires collaboration with Product Management, AI Engineering, and Revenue Cycle

Qualifications

• Bachelor's degree in Nursing, Health Information Management, Medicine, Physician Assistant Studies, or a related clinical field.
• 5+ years of Prior Authorization experience within provider organizations, health systems, payer organizations, or Revenue Cycle Management.
• Strong understanding of medical necessity documentation.
• Experience with commercial, Medicare, and Medicaid prior authorization requirements.
• Knowledge of payer portals and authorization workflows.
• Experience with ICD-10-CM, CPT, and HCPCS coding fundamentals.
• Familiarity with Electronic Health Records (EHRs) and practice management systems.

Responsibilities

• Validate AI-Driven Prior Authorization Workflows and determine AI performance against payer rules and documentation.
• Audit AI-generated Authorization Packages ensuring completeness and correctness.
• Evaluate AI Decision Quality across documentation, medical necessity, and payer requirements.
• Perform AI Quality Audits measuring accuracy, automation, and KPI trends.
• Provide structured feedback to Product Management and Engineering for product improvements.
• Develop payer rule knowledge bases and reference scenarios to support AI decisions.

Skills

Clinical judgment

Analytical skills

Attention to detail

Documentation gaps

Root cause analysis

Data-driven decisions

Cross-functional collaboration

Education

Bachelor's degree in Nursing/Health Information Management/Medicine

Tools

EHR systems

Practice management systems

Payer portals

Job description

DeliverHealth Solutions is seeking an experienced Prior Authorization Specialist to support InstaAuth, our AI-powered PA platform. You will evaluate AI-driven workflows, validate clinical documentation, and ensure payer requirements are met, bridging clinical and product teams to improve automation and reliability.

This role emphasizes product quality and clinical AI, not direct submission of authorizations, and requires collaboration with Product Management, AI Engineering, and Revenue Cycle