Prior Authorization Specialist - Remote

Overview

The Prior Authorization Specialist will be a key member of the product team, supporting SmarterDx’s newest product launch to help health systems capture the full value of care delivered. You will bring creativity and clinical insight to provide feedback for our proprietary clinical AI models; ensuring they accurately reflect real-world workflows and payer behaviors.

In Short

• Act as SmarterDx’s internal expert on prior authorization workflows, payer requirements, and best practices
• Partner with product managers, engineers, designers, and data scientists to design and validate new product features focused on clinical intelligence for authorizations
• Review, organize, and label real-world prior authorization data to support model training and performance evaluation
• Identify and communicate gaps, edge cases, and nuances in prior authorization logic
• Evaluate AI model outputs for accuracy, completeness, and clinical alignment
• Collaborate with teams to translate customer needs into actionable product feedback
• Document payer-specific rules, coding variations, and decision patterns
• Contribute to internal knowledge bases and develop scalable QA and labeling processes

Requirements

• RN or other clinical background required
• 5+ years of hands-on experience managing medical prior authorizations
• Deep understanding of medical necessity documentation and payer-specific criteria
• Proven experience submitting and managing outpatient prior authorizations
• Comfort working across multiple payer platforms and navigating denials
• Strong analytical skills with clear workflow logic explanation
• Curiosity and adaptability to work in a cross-functional environment
• Experience using EMRs and payer portals

Benefits

• Comprehensive Medical, Dental & Vision plans
• Free One Medical Membership with enrollment in a medical plan
• Generous Paid Parental Leave
• Remote-First Team with home office reimbursement stipend
• Unlimited PTO & 10 Holidays
• $500 Learning & Development Budget
• 401(k) with Traditional & Roth Options
• Minimal Bureaucracy
• Work alongside smart, supportive colleagues