Specialty Medications Prior Authorization Specialist

Job Description

Insight Global is seeking a fully remote Specialty Medications Prior Authorization Specialist to support a Healthcare AI client. This is a fully remote, part-time opportunity working 5-15 hours/week where candidates will leverage their prior authorization expertise to evaluate and improve AI-driven authorization strategies. This role is highly analytical and requires a strong understanding of payer policies, documentation strategies, and real-world authorization workflows. Laptop and equipment will be provided.

Responsibilities:

• Review ~10 cases/week
• Evaluate AI-generated prior authorization recommendations and strategies
• Assess the quality, logic, and effectiveness of AI recommendations across multiple payers and clinical policies
• Identify gaps where AI recommendations differ from real-world prior authorization best practices and explain discrepancies
• Provide detailed insights into payer-specific nuances, including portal workflows, policy requirements, and documentation phrasing strategies
• Share operational knowledge with product teams to enhance AI-powered authorization processes
• Partner with GTM teams to critique presentations and provide subject matter expertise on prior authorization workflows

Skills and Requirements

• 3+ year of prior authorization experience within a hospital or large multi-specialty group
• Experience completing prior auths for at least two specialties such as: GLP-1s/weight loss, oncology, derm, autoimmune (biologics), IV infusion, neuromeds, etc.
• Experience working across multiple payer types (commercial, Medicare Advantage, Medicaid managed care)
• Hands-on experience with at least one major payer portal system
• Strong understanding of prior authorization workflows, payer rules, and documentation requirements
• Ability to think critically and explain reasoning behind authorization decisions
• CPC certification or equivalent medical coding knowledge (CPT, ICD-10, modifiers, payer guidelines)
• Experience working in roles that involve denial management or coding review
• Comfort working in a tech-enabled or AI-supported healthcare environment

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].