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 checkpoint that keeps the work clean.
- Keep the EHR accurate. Enter and maintain authorization and patient information with precision. Current, error-free records are non-negotiable.
- Track and report. Use Excel (including pivot tables) to monitor authorization volume, approval rates, turnaround, and denials, and surface where things are slipping.

What we're looking for

Experience

- 2–3 years managing prior authorizations for U.S. facilities (required). This is the core of the role, not a side skill — you should have owned the full authorization-to-appeal process at volume.
- Experience in a similar outpatient setting — speech therapy (ST), occupational therapy (OT), ABA, imaging or behavioral health.
- Hands-on experience with EHR systems (required).
- Direct experience working with U.S.-based companies and familiarity with the U.S. healthcare system (required).

Insurance know-how





- Strong grasp of insurance procedures and terminology — CPT codes, ICD, SCA, medical necessity criteria — including authorizations, re-authorizations, denials, and appeals.

Quality mindset

- Track record of catching errors and ensuring accuracy in a high-volume environment; comfortable being accountable for outcomes, not just task completion.

Tools & portals

- Hands-on experience with Availity, and payer/insurance portals for submitting and follow ups.

Language

- Fully bilingual, with English at a minimum B2 or C1 level.

Education

- Bachelor's degree preferred; Associate's degree considered. Substantial equivalent experience in healthcare administration also considered.

Who thrives here

- Detail-obsessed and highly organized, with the ability to juggle many moving pieces without dropping any.
- Takes ownership of outcomes and quality, not just the checklist.
- Persistent and unflappable when chasing payers and fighting denials.
- A strong, warm communicator who genuinely wants to help families get to care.
- Comfortable working independently and as part of a team in a fast-paced, tech-driven environment.
- Steady under pressure and able to hit tight deadlines.

The fine print This is a remote role for a Colombia-based candidate working directly with some of the largest healthcare providers in the U.S. You'll work U.S. time zones and follow the U.S. holiday calendar.

We're not hiring for a 9-to-5. We're hiring someone who's curious, learns fast, and is excited to grow into a successful career while taking on new challenges along the way.

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