Prior Authorization Specialist at Claim Health New York, NY

Claim Health; New York (NY); On-site; USD 65,000 - 90,000; Full time

Job summary

Healing Strides Counseling seeks an experienced Prior Authorization Specialist to support automation for home health and hospice. You will ensure authorizations align with payer requirements and help translate complex rules into scalable workflows.

Join a fast-moving startup where you’ll partner with product, engineering, and client teams to reduce turnaround times, monitor denial trends, and build SOPs that cover Medicare Advantage, Medicaid, and commercial payers.

Qualifications

• 3+ years of prior authorization in home health, hospice, or post-acute care.
• Deep knowledge of Medicare Advantage, Medicaid, managed Medicaid, and commercial payers.
• Experience obtaining authorizations across multiple payer portals.
• Strong organizational skills and attention to detail; experience documenting workflows.

Responsibilities

• Audit authorization workflows.
• Review automation-generated requests for completeness, accuracy, and turnaround time.
• Improve automation by translating payer rules into scalable workflows.
• Build payer playbooks and SOPs across Medicare Advantage, Medicaid, and state programs.
• Partner with clients to align automation with agency workflows.
• Track performance metrics and drive continuous improvement.

Skills

Prior authorization experience

Medicare & Medicaid knowledge

Workflow documentation

Independent startup environment

Attention to detail

Education

Clinical background (RN/LPN or similar)

Tools

HomeCare HomeBase (HCHB)

Axxess

WellSky

KanTime

Job description

About the Role

We're hiring an experienced Prior Authorization Specialist to help build the future of authorization automation for home health and hospice. Prior authorization is one of the largest operational bottlenecks for agencies. Our platform automatically verifies benefits, gathers documentation, submits authorizations, follows up with payers, and monitors approval status. Your role is to ensure those automations run accurately, efficiently, and according to payer requirements. You'll combine deep operational knowledge with process improvement, helping us encode payer-specific workflows into software that scales across thousands of authorization requests. This isn't a traditional authorization desk role. It's an operations role for someone who understands the complexity of authorizations and wants to help automate them.

What You'll Do

• Audit authorization workflows
• Review authorization requests completed by our automations for completeness, accuracy, and turnaround time. Identify recurring failure points and determine whether issues stem from payer requirements, documentation, or automation logic.
• Improve authorization automation Partner with product and engineering teams to translate complex payer rules into scalable workflows. Help define escalation logic, documentation requirements, follow-up cadences, and exception handling.
• Build payer playbooks Create and maintain SOPs covering authorization workflows across Medicare Advantage, Medicaid, managed Medicaid, commercial payers, and state-specific requirements.
• Partner with clients Meet with intake, authorization, and billing teams to understand agency workflows, resolve escalations, and configure automation to match operational needs.
• Track operational performance Monitor authorization turnaround times, approval rates, denial trends, escalation volume, payer response times, and automation success metrics. Drive continuous improvement initiatives.

What We're Looking For

Required

• 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 HomeCare HomeBase (HCHB), Axxess, WellSky, and KanTime preferred
• Strong organizational skills with excellent attention to detail
• Experience documenting workflows or SOPs
• Comfortable working independently in a fast-moving startup

Nice to Have

• RN, LPN, or clinical background
• Experience with Careport, Forcura, Ensocare, or referral management platforms
• Experience working with automation or RCM software vendors
• Knowledge of hospice-specific authorization requirements and Medicaid room & board processes

Why This Role

Multiply your impact. Your expertise becomes automation that processes thousands of authorizations every month. Solve hard operational problems. Help eliminate one of the biggest administrative burdens in post-acute care. Build the future. Join an early-stage healthcare AI company where your knowledge directly shapes the product roadmap.