Prior Authorization Specialist (Healthcare)

TL;DR

Prior Authorization Specialist (Healthcare): Managing the full lifecycle of prior authorization workflows for pain management and orthopedic procedures with an accent on payer requirements and documentation standards. Focus on reducing preventable denials, navigating pharmacy benefit portals, and ensuring timely approvals for complex medical procedures.

Location: Remote (Must be based in the US)

Company

hirify.global is a Series B startup partnering with MSK provider groups to optimize clinic operations and improve financial performance.

What you will do

• Submit and manage prior authorizations for pain management and orthopedic procedures, including injections, RFA, and surgical procedures.
• Handle prior authorizations and reauthorizations for medications, navigating pharmacy benefit portals and step-therapy requirements.
• Verify insurance eligibility and benefits across multiple payer portals efficiently.
• Review provider documentation to ensure medical necessity and alignment with procedural codes.
• Follow up on pending or denied authorizations and identify documentation gaps to reduce preventable denials.
• Maintain precise records within EHR and tracking systems to support billing reconciliation.

Requirements

• 3+ years of prior authorization experience in Pain Management or Orthopedics.
• Experience working on the clinic/provider side (not hospital/facility billing).
• Proficiency with payer portals such as Availity, UHC, Carelon/AIM, eviCore, and CoverMyMeds.
• Strong working knowledge of CPT codes and procedural terminology.
• Ability to independently manage a high volume of daily authorization requests.
• English: B2+ proficiency required for communication with payers and providers.

Nice to have

• Experience with Medicaid plans, specifically AHCCCS.
• CPC-A or other professional coding certifications.
• Familiarity with NCCI edits, bundling rules, and step therapy protocols.

Culture & Benefits

• Fast-paced startup environment emphasizing speed, adrenaline, and rapid execution.
• Culture of persistence and extreme ownership of outcomes.
• Focus on personal and professional growth through embracing challenges and learning from failure.
• Value placed on direct, constructive feedback and extreme attention to detail.