Prior Authorization Automation Specialist

Claim Health; New York (NY); On-site; USD 90,000 - 130,000; Full time

Job summary

Claim Health is hiring a Prior Authorization Specialist to build automation for home health and hospice in New York. You will help ensure authorizations run accurately, efficiently, and per payer requirements as part of an automation platform.

You’ll audit workflows, translate payer rules into scalable processes, and create payer playbooks covering Medicare Advantage, Medicaid, and commercial payers. Collaborate with intake, authorization, and billing teams to align operations, monitor metrics,

Qualifications

• 3+ years of prior authorization experience within home health, hospice, or post-acute care.
• Deep familiarity with Medicare Advantage, Medicaid, managed Medicaid, commercial insurance, and authorization workflows.
• Experience obtaining authorizations across multiple payer portals.
• Strong understanding of eligibility verification, authorization documentation requirements, and referral workflows.
• Experience with the listed home health software platforms is preferred.
• Strong organizational skills with excellent attention to detail.

Responsibilities

• Audit authorization workflows for completeness, accuracy, and turnaround time.
• Improve authorization automation by translating payer rules into scalable workflows.
• Build payer playbooks covering Medicare Advantage, Medicaid, and commercial payers.
• Partner with intake, authorization, and billing teams to match operational needs.
• Track turnaround times, denial trends, escalation volume, and automation success metrics.

Skills

Prior authorization

Home health

Hospice

Medicare Advantage

Medicaid

Payer portals

Automation

SOPs

Documentation

Independent work

Tools

HomeCare HomeBase (HCHB)

Axxess

WellSky

KanTime

Careport

Forcura

Ensocare

Job description

Claim Health is hiring a Prior Authorization Specialist to build automation for home health and hospice in New York. You will help ensure authorizations run accurately, efficiently, and per payer requirements as part of an automation platform.

You’ll audit workflows, translate payer rules into scalable processes, and create payer playbooks covering Medicare Advantage, Medicaid, and commercial payers. Collaborate with intake, authorization, and billing teams to align operations, monitor metrics,