Prior Authorization Assistant

Caya Health; Puerto Rico; On-site; USD 55,000 - 75,000; Full time

Job summary

Caya Health is seeking an experienced Prior Authorization Specialist to operate in an AI-enabled environment. You will process U.S. prior authorizations, verify coverage, and gather documentation across multiple specialties.

You will also oversee automated submissions, identify exceptions, and help refine the technology behind the workflows. The role requires strong English communication, attention to detail, and the ability to manage high volumes while maintaining quality.

Qualifications

• 4+ years in U.S. healthcare operations, focusing on prior authorization, medical billing, or revenue cycle.

Responsibilities

• Process prior authorizations for U.S. healthcare providers across multiple specialties.
• Verify insurance coverage, eligibility, and authorization requirements.
• Gather and review clinical and administrative documentation for submission.
• Submit authorization requests through payer portals, phone, fax, and other channels.
• Monitor pending authorizations and follow up with payers until cases are resolved.
• Identify missing information or issues that could delay approval.
• Maintain clear documentation of every case and action taken.
• Oversee AI-enabled workflows and intervene when human judgment is needed.
• Provide feedback to help improve automation and workflows.

Skills

Healthcare operations experience

Prior authorization

Payer portals

English communication

Tools

Epic

Job description

We’re looking for experienced healthcare professionals who want to take that expertise into an AI-enabled environment.

You already know how complicated U.S. healthcare can be. You’ve worked with insurance companies, provider offices, patient records, payer portals, and authorization requirements. You know that getting an authorization approved takes more than following a checklist—it takes experience, persistence, and good judgment.

As a Prior Authorization Specialist, you’ll process prior authorizations for U.S. healthcare providers while working alongside technology designed to automate more of the administrative work behind them.

This is a hands-on role. You’ll still work directly on authorizations, but you’ll also oversee automated submissions, identify when something needs human intervention, resolve exceptions, and help us improve the technology itself.

What You’ll Do

• Process prior authorizations for U.S. healthcare providers across multiple specialties.
• Verify insurance coverage, eligibility, and authorization requirements.
• Gather and review the clinical and administrative documentation required for submission.
• Submit authorization requests through payer portals, phone, fax, and other required channels.
• Monitor pending authorizations and follow up with payers until cases are resolved.
• Identify missing information, discrepancies, and other issues that could delay approval.
• Maintain clear, accurate documentation of every case and action taken.
• Respond to authorization status questions and help resolve escalated or complex cases.
• Oversee work completed through AI-enabled and automated workflows, stepping in when human judgment is required.
• Identify when automation gets something wrong or when a workflow could work differently.
• Share feedback directly with the teams building the technology so we can continuously improve how the work gets done.
• Stay current on payer requirements, policies, and authorization processes.

What We’re Looking For

This is an experienced role. You should already be comfortable navigating U.S. healthcare and prior authorization independently. You’ll be a strong fit if you have:

• 4+ years of experience in U.S. healthcare operations, with significant experience in prior authorization, medical billing, revenue cycle, or a closely related function.
• Hands-on experience processing prior authorizations from beginning to end.
• Experience working across multiple specialties. Experience in areas such as oncology/hematology, cardiology, physical therapy, pharmacy, hospital/post-acute care, or outpatient specialty care is especially valuable.
• Experience working with major U.S. payers such as UnitedHealthcare, Aetna, and Blue Cross Blue Shield.
• Experience navigating payer portals and healthcare systems. Epic experience is especially valuable.
• Strong written and spoken English and the ability to communicate professionally with U.S.-based healthcare teams.
• The judgment to recognize when something looks wrong rather than simply moving a case forward.
• Strong attention to detail and a high standard for accuracy.
• The ability to manage a high volume of work without sacrificing quality.
• Comfort learning new technology and working in an environment where processes continue to evolve.
• Reliable follow-through—you take ownership of a case rather than waiting for someone else to tell you what to do next.

This Role Might Feel Different From What You’re Used To

Your experience is the entry bar. We aren't looking for someone to train from the beginning. The years you've spent learning U.S. healthcare, payer requirements, and prior authorization workflows are exactly what make you valuable here.

Work at the forefront of AI-enabled healthcare.

You’ll use technology that is changing how administrative healthcare work gets done. Your role isn't simply to use the technology-you'll apply your healthcare expertise to determine when it works, when human judgment is needed, and where it can improve.

You have a voice in what we build.

The people doing the work often understand healthcare workflows better than anyone else. You'll have opportunities to share what you're seeing with the people building the technology and influence how those workflows evolve.

You're measured on the quality of your work.

This is an outcome-driven environment. We care about accurate work, good judgment, ownership, responsiveness, and getting cases across the finish line.

What Success Looks Like

• You don't guess when you're unsure. You investigate.
• You don't let an authorization sit because the payer hasn't responded. You follow up.
• You don't assume an automated result is correct because the system produced it. You use your experience to recognize when something doesn't make sense.
• And when you see the same problem happening again and again, you don't just work around it-you help us figure out how to solve it.