Remote Prior Authorization Specialist | Payer Reimbursement

Koya Medical, Inc.; United States; Remote; USD 55,000 - 60,000; Full time

Job summary

Koya Medical, Inc. seeks a detail-oriented Prior Authorization Specialist to ensure timely payer approvals by managing authorizations, precertifications and referrals across multiple health plans.

You will educate payers on product features to support coverage and reimbursement while collaborating across departments to optimize patient access. Reporting to the Manager of Reimbursement Operations, this full-time, remote role requires 3+ years in prior authorization/reimbursement, strong insurance

Qualifications

• High school diploma required; Associate’s or Bachelor’s degree preferred.
• Minimum 3 years of experience in prior authorization and reimbursement processes.
• Background in medical devices, healthcare reimbursement, or related field.
• Strong understanding of insurance processes and authorization workflows.

Responsibilities

• Submit medical records and documentation to payers for coverage approval.
• Review clinical documentation to determine medical necessity.
• Process authorizations, precertifications, predeterminations, and referrals.
• Educate payers on product features and benefits to support coverage.
• Communicate payer findings clearly to internal stakeholders.

Skills

Insurance processes

Communication skills

Attention to detail

Independent and collaborative work

Payer portals navigation

Education

High school diploma

Associate's or Bachelor's degree preferred

Tools

Salesforce

Job description

Koya Medical, Inc. seeks a detail-oriented Prior Authorization Specialist to ensure timely payer approvals by managing authorizations, precertifications and referrals across multiple health plans.

You will educate payers on product features to support coverage and reimbursement while collaborating across departments to optimize patient access. Reporting to the Manager of Reimbursement Operations, this full-time, remote role requires 3+ years in prior authorization/reimbursement, strong insurance