Research and document prior authorization and benefit verification requirements across diverse payors (commercial plans, state Medicaid programs, etc.)
Investigate payor-specific submission processes: required documents, portals, fax numbers, CPT code requirements, and policy updates
Stay informed on payor policy changes, especially those affecting authorization processes and benefit structures
Navigate payor websites, newsletters, and representative communications to gather accurate, up-to-date information
Validate information from multiple sources and determine credibility of payor guidance
Work independently to solve ambiguous problems where established processes don't yet exist
Communicate findings clearly to cross-functional stakeholders and adapt quickly to feedback
Handle tight deadlines and shifting priorities in a fast-paced startup environment

Prior authorization and/or insurance verification experience at a healthcare clinic
Deep familiarity with payor submission processes and how requirements vary across different insurance plans
Strong research skills and comfort navigating payor portals, websites, and documentation
Exceptional attention to detail and ability to spot common authorization mistakes
Experience working with multiple payors and understanding process variations
Demonstrated ability to build or improve processes when protocols don't exist
Resilient problem-solver who thrives in ambiguous, evolving environments
Strong communication skills and comfort asking for help when needed
Humility and willingness to learn from mistakes

Authorization and Verification Research Specialist

Key skills