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 (Colombia)
🏢 Solum Health (YC 22)
📍 Colombia