Prior Authorization Specialist

Remote (Colombia) · U.S. Time Zones · Outpatient Healthcare

Why this role exists

For most outpatient care in the U.S., nothing happens until the payer says yes. A clean, complete prior authorization is the difference between a patient starting therapy this week and waiting a month — and between a clinic getting paid and eating a denial. It's detailed, deadline-driven work, and when it's done well, families never even know how much went on behind the scenes.

You'll own that work. As a Prior Authorization Specialist, you'll obtain and manage authorizations end to end for outpatient practices across speech therapy, occupational therapy, ABA, imaging, infusion centers, and behavioral health — the partners we support across the U.S. You won't just submit requests; you'll be accountable for the quality of every submission and the outcomes it produces.

This isn't a clock-in, clock-out job. We're looking for someone curious, fast to learn, and hungry to build a real career in U.S. healthcare operations.

What you'll do




- Obtain authorizations end to end. Build and submit prior authorization requests, track them through the payer, follow up persistently, and confirm approval before services are delivered.
- Get the clinical story right. Gather and review the documentation payers require — clinical notes, CPT/ICD codes, medical necessity — and make sure each submission is complete and accurate the first time.
- Manage the full lifecycle. Track authorization status, expiration dates, units, and re-authorizations so nothing lapses and no care is delivered without coverage in place.
- Fight denials. Identify why requests are denied, prepare and submit appeals, and coordinate peer-to-peer reviews to overturn them.
- Own quality and outcomes. Review your own and the team's authorizations for accuracy, catch problems before they become denials or delays, and make sure approval-rate and turnaround targets are consistently met. You're the checkpoin

📌 Authorization Specialists (Colombia)
🏢 Solum Health (YC 22)
📍 Colombia