Remote Prior Authorization Specialist

Insight Global is seeking a fully remote Prior Authorization Specialist to support a Healthcare AI client. This is a fully remote, part-time opportunity working 10-20 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.

Shift Times: Flexible scheduling within Monday-Friday, 9am-8pm PST (can't work weekends)
(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)
Duration: 3-month contract (potential to extend)

Responsibilities:
• Review pending authorization requests and 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

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 opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their 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 recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

• 3+ year of prior authorization experience within a hospital or large multi-specialty group
• 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

Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.