Prior Authorization Specialist

Claim Health is the AI Revenue Platform for Post-Acute Care. We're building the revenue infrastructure that lets home-based care providers focus on care instead of chasing revenue.

Across the country, agencies are delivering life-changing care every day, but they're doing it with systems built for a different era. Faxed referrals. Manual authorization tracking. Billing teams spending weekends reconciling spreadsheets. Revenue lost not because care wasn't delivered, but because the tools weren't built to support it.

We think the teams doing the hardest work in healthcare deserve better.

We're rebuilding revenue operations from the ground up: replacing fragmented, manual workflows with AI-powered systems that prevent problems upstream, automate the heaviest work downstream, and give operators real-time visibility into what's actually happening across their business.

We're growing fast and there's a massive amount left to build.

If you want to work on hard problems that matter, with a team that moves fast and builds things people actually rely on, we'd love to hear from you.

📧 founders@claimhealth.ai

🌐 www.claimhealth.com

We're hiring an experienced Prior Authorization Specialist to help build the future of authorization automation for home health and hospice.

Prior authorization is one of the largest operational bottlenecks for agencies. Our platform automatically verifies benefits, gathers documentation, submits authorizations, follows up with payers, and monitors approval status. Your role is to ensure those automations run accurately, efficiently, and according to payer requirements.

You'll combine deep operational knowledge with process improvement, helping us encode payer-specific workflows into software that scales across thousands of authorization requests.

This isn't a traditional authorization desk role. It's an operations role for someone who understands the complexity of authorizations and wants to help automate them.

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.

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.

Create and maintain SOPs covering authorization workflows across Medicare Advantage, Medicaid, managed Medicaid, commercial payers, and state-specific requirements.

Meet with intake, authorization, and billing teams to understand agency workflows, resolve escalations, and configure automation to match operational needs.

Monitor authorization turnaround times, approval rates, denial trends, escalation volume, payer response times, and automation success metrics. Drive continuous improvement initiatives.

• 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

• RN, LPN, or clinical background
• Experience with Careport, Forcura, Ensocare, or referral management platforms
• Experience working with automation or RCM software vendors
• Knowledge of hospice-specific authorization requirements and Medicaid room & board processes

Multiply your impact. Your expertise becomes automation that processes thousands of authorizations every month.

Solve hard operational problems. Help eliminate one of the biggest administrative burdens in post-acute care.

Build the future. Join an early-stage healthcare AI company where your knowledge directly shapes the product roadmap.

Claim Health is solving one of healthcare’s most complex and fragmented problems, revenue cycle management in at-home care, with a modern, AI-native tech stack.

• TypeScript across the stack
• Node.js and tRPC for backend services
• React with Tailwind
• LLMs and Voice AI to power real-time documentation, denials analysis, and agentic workflows
• Mastra and custom agents to build autonomous systems that take real actions to get claims reimbursed

• Fully automating complex multi-step billing workflows with minimal human input
• Parsing unstructured documentation and mapping it to payer-specific rules using AI
• Building scalable automation to integrate with disparate data sources
• Designing agentic systems that collaborate across human, API, and UI layer, with accountability, retries, and memory

We’re pushing the frontier of what AI can do in production, on real revenue, in highly regulated environments. If you’re excited about building agents that do real work (not just demos) this is your playground.