Medicare Authorization Consultant

Konsus, Inc. (Superside); United States; Remote; USD 80,000 - 120,000; Full time

Job summary

A leading healthcare consulting firm seeks a Medicare Prior Authorization Consultant to support remote healthcare operations. The role involves providing expert-level consultation and guidance on prior authorization programs, ensuring compliance with CMS regulations and optimizing workflows. Candidates should have extensive Medicare Advantage experience and advanced degrees or certifications in healthcare.

Qualifications

• 7+ years of Medicare Advantage prior authorization experience.
• In-depth knowledge of CMS policies and MAC operations.
• Experience managing over 10,000 authorization programs annually.

Responsibilities

• Provide expert consultation on Medicare Advantage prior authorization operations.
• Guide development and implementation of scalable prior authorization programs.
• Ensure alignment with CMS regulations and optimize workflows.

Skills

Medicare Advantage prior authorization experience

Knowledge of CMS policies

High-volume prior authorization management

Clinical criteria review

Medical necessity evaluation

Education

MHA

MPH

MBA

Healthcare certifications (CHC, CHPC)

Job description

A company is looking for a Medicare Prior Authorization Consultant to support healthcare operations remotely.

Key Responsibilities

• Provide expert-level consultation on Medicare Advantage prior authorization operations
• Guide the development and implementation of scalable prior authorization programs
• Ensure alignment with CMS regulations and optimize authorization workflows

Qualifications and Skills

• 7+ years of Medicare Advantage prior authorization experience
• In-depth knowledge of CMS policies and Medicare Administrative Contractor (MAC) operations
• Experience managing high-volume prior authorization programs (10,000+ annually)
• Familiarity with clinical criteria review and medical necessity evaluation
• Advanced degree (MHA, MPH, MBA) or healthcare certifications (CHC, CHPC) preferred