Prior Authorization Specialist
About the role
Experienced operations professional focused on building automated prior authorization workflows for home health and hospice within Claim Health's AI Revenue Platform for Post-Acute Care.
Responsibilities
- 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.
Qualifications
- 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
About Claim Health
The first AI revenue platform for post-acute healthcare
Post-acute agencies lose up to 15% of revenue each year to denials, non-compliant documentation, and delayed payments. Most treat it as a cost of doing business. Instead of waiting weeks for rejections and appealing claims one by one, Claim Health flags issues in real-time and automates claim corrections and appeals—before revenue is lost. While working with healthcare providers, we found most denials stem from small, preventable documentation errors. As payor requirements grow increasingly complex and fragmented, billing has become a manual, error-prone process. Claim Health closes the loop between documentation and billing outcomes—using AI to detect issues, automate workflows, and recover thousands in missed revenue each week. Kevin and JJ bring nearly a decade of experience building and scaling healthtech companies. At Dandy, JJ was a founding engineer and Kevin was the first GTM hire; together they helped grow the business from 0 to $150M+ ARR. At Perry (now Jolly), JJ led engineering and Kevin was Head of Sales, driving the company through a $16.5M Series A led by Tesla’s former CFO. In under three weeks since incorporation, we've launched with three agencies and are in early discussions with large U.S. health systems. Post-acute care is a $400B market with over $20B in annual revenue leakage due to broken billing workflows. Claim Health is fixing that—starting with denials, and expanding into the full revenue cycle stack.
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