Prior Authorization Specialist

Location: Fully remote; must be able to support EST hours

Salary: $29.56–$33.80 USD per hour

Company

hirify.global provides genomic and clinical data services that support diagnosis, treatment decisions, drug discovery, and precision medicine.

What you will do

• Review and resolve prior authorization inquiries, rejected authorizations, and related cases in Salesforce.
• Research denied authorizations and prepare appeals with medical records, documentation, and clinical justification.
• Submit, track, and follow up on prior authorization requests and appeal outcomes.
• Communicate with healthcare providers and insurance companies to facilitate peer-to-peer reviews.
• Collaborate with clinical, billing, market access, and insurance teams to resolve authorization issues.
• Provide management with regular updates and monitor changes in payer guidelines and requirements.

Requirements

• 3–5 years of healthcare billing experience focused on prior authorizations and appeals.
• Strong understanding of insurance policies, authorization and verification processes, medical terminology, and coding.
• Knowledge of HIPAA regulations and major health plan requirements.
• Strong communication, interpersonal, organizational, and attention-to-detail skills.
• Experience with Google Apps, Mac OS X, and CRM applications.
• Ability to support EST hours; a high school diploma is preferred.

Nice to have

• Experience with Xifin, Salesforce, or Careviso.

Culture & Benefits

• Fully remote work from a home office or another suitable remote location.
• Work requires reliable high-speed internet and standard computer, phone, and video conferencing equipment.
• Collaborative environment focused on urgency, ownership, continuous learning, and patient impact.
• Competitive compensation and benefits aligned with local market practices and legal requirements.