Prior Authorization Specialist

We are seeking a highly organized, detail-driven Prior Authorization Specialist with deep expertise in Skilled Nursing Facility (SNF) authorizations. In this fully remote role, you will secure, track, and extend pre-authorizations and concurrent reviews with commercial payors, Medicare Advantage, and Medicaid plans. The ideal candidate combines exceptional written and verbal English communication skills with sharp attention to detail and the ability to manage a high volume of complex patient cases across multiple channels at once.

Key Responsibilities

Authorization Retrieval & Tracking: Submit, track, and secure initial and concurrent prior authorizations for Skilled Nursing Facility (SNF) admissions and continued stays.

Concurrent Review Management: Monitor length of stay (LOS), submit clinical updates to payors in a timely manner, and manage re-certifications to prevent authorization gaps or coverage denials.

High-Volume Communication: Track, document, and manage heavy daily correspondence across payor portals, phone, email, and EHR systems.

Payor Interface: Liaise daily with insurance case managers, medical directors, and utilization management teams to advocate for patient coverage.

Denial & Appeal Support: Identify authorization denials or peer-to-peer requirements and coordinate quickly with clinical and billing teams to initiate appeals.

Documentation & Data Integrity: Maintain detailed, accurate audit trails of authorization numbers, effective dates, approved units/days, and payor notes in the system.

Qualifications & Requirements

Experience: 2-4 years of direct experience handling prior authorizations and utilization management, specifically for Skilled Nursing Facilities (SNF).

Payor Knowledge: In-depth familiarity with Medicare Advantage, Medicaid managed care organizations, and major commercial health insurance authorization workflows (e.g., NaviHealth, CareCentrix, Availity).

Communication Skills: Fluent/native-level English proficiency (spoken and written) is required for frequent phone calls with insurance companies and detailed clinical documentation.

Multi-Tasking & Organization: Proven ability to manage a high volume of cases, track multiple deadlines concurrently, and maintain accuracy under pressure.

Technical Proficiency: Experience with healthcare EHR/EMR platforms, payor portals, Excel/Google Sheets, and cloud-based task management software.

Shift Availability: Must be available to work dedicated hours aligned with the US Eastern Time Zone (ET).