PRIOR AUTHORIZATION SPECIALIST

Role Summary

Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. As a Prior Authorization Specialist, you will coordinate prior authorization requests for scheduled procedures, treatments, and services on behalf of provider clients. You will work with payer portals, provider teams, and clinical documentation to help secure timely approvals and resolve authorization-related issues.

Responsibilities

• Submit and track prior authorization requests across multiple insurance payers
• Gather and review clinical documentation required to support authorization requests
• Communicate with provider teams to obtain missing information or documentation
• Follow up with payers on pending requests and monitor authorization status through resolution
• Identify authorization issues and pursue reconsiderations or appeals when requests are denied
• Maintain accurate records of authorization requests, decisions, and follow-up actions
• Stay current on payer-specific authorization requirements and communicate relevant changes to the team
• Escalate delays, complex cases, and potential barriers to timely patient care when appropriate

Requirements

• 2+ years of experience in prior authorization, insurance verification, medical billing, or a related healthcare role
• Experience working with insurance payer portals and authorization requirements
• Ability to understand and interpret clinical documentation
• Strong attention to detail and ability to manage multiple authorization requests simultaneously
• Persistence and strong follow-through when working through multi-step authorization or appeal processes
• Strong written and verbal communication skills when working with providers, payers, and internal teams
• Ability to work independently while meeting productivity and turnaround expectations
• HIPAA-compliant private workspace and ability to work effectively in a fully remote role

NICE TO HAVE

• Experience with specialty-specific prior authorizations
• Pharmacy prior authorization experience
• Clinical or healthcare background
• Experience with an EMR system such as Epic, Athena, or eClinicalWorks
• Experience handling authorization denials, reconsiderations, or appeals

Salary

Compensation will be discussed during the interview and will reflect the candidate’s experience, qualifications, and relevant healthcare revenue cycle expertise.

Benefits and additional employment details will be discussed during the hiring process.

Additional Information

Application review → introductory conversation → hiring manager interview → offer.

Raventra Health is an equal opportunity employer. We consider all qualified applicants without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic. If you need an accommodation at any stage of the hiring process, please contact us and we will work with you to provide appropriate support.

Location: Remote