Specialty Medications Prior Authorization Specialist

Required Skills & Experience

• 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

Nice to Have Skills & Experience

• 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

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