Prior Authorization Specialist - AI-Enabled Healthcare Ops

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

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.