Prior Authorization Specialist

Koya Medical, Inc. is seeking a detail-oriented and motivated Prior Authorization Specialist to join its Reimbursement Operations team. This remote position plays a key role in securing timely insurance approvals, managing authorization processes, and supporting reimbursement operations for innovative healthcare solutions.

The successful candidate will handle prior authorizations, precertifications, predeterminations, and referrals across multiple health insurance plans. The role requires strong knowledge of healthcare reimbursement processes, insurance workflows, and the ability to communicate effectively with payers and internal teams.

This opportunity is ideal for a healthcare reimbursement professional who is organized, proactive, and passionate about improving patient access to medical care through efficient authorization management.

Key Responsibilities:

• Submit medical records and supporting documentation to insurance payers for coverage approvals, network exceptions, and single-case agreements.

• Review clinical documentation to determine medical necessity and support authorization requests.

• Process prior authorizations, referrals, precertifications, and predeterminations across various health insurance plans.

• Educate payers about product features and benefits to support coverage and reimbursement decisions.

• Communicate payer requirements, updates, and process findings clearly to internal teams.

• Collaborate with internal departments to ensure accurate patient order processing.

• Maintain compliance with HIPAA regulations and healthcare industry requirements.

• Monitor accuracy, productivity, and quality standards while managing authorization workflows.

• Assist in developing internal processes, workflows, and best practices.

Requirements:

• High School Diploma required; Associate’s or Bachelor’s Degree preferred.

• Minimum 3 years of experience in prior authorization and reimbursement processes.

• Experience in medical devices, healthcare reimbursement, or a related healthcare field.

• Strong understanding of insurance procedures and authorization workflows.

• Excellent written and verbal communication skills.

• Strong attention to detail with excellent organizational and multitasking abilities.

• Ability to work independently and collaborate effectively in a remote environment.

• Experience using payer portals and Salesforce CRM.

• Ability to prioritize tasks, manage deadlines, and work efficiently under pressure.

Strong knowledge of:

• Healthcare insurance processes, reimbursement operations, and prior authorization procedures.

• Medical documentation review and payer communication.

• Salesforce CRM, Microsoft Office Suite, Google Suite, and Adobe tools.

• HIPAA compliance and healthcare regulatory requirements.