Authorization and Verification Research Specialist

Silna Health

Job Overview

Location

Remote

Job Type

Full-time

Full Job Description

📋 Description

• As an Authorization and Verification Research Specialist at Silnahealth.Com, you will play a pivotal role in demystifying the complex landscape of insurance payor requirements. This fully remote, full-time position is designed for a highly analytical and detail-oriented individual who possesses a deep understanding of insurance verification and prior authorization processes. Your primary mission will be to conduct in-depth research into the specific requirements of various insurance plans, meticulously investigating payor portals, policy updates, and submission procedures. You will be the cornerstone of our knowledge base, uncovering the precise steps necessary to successfully submit prior authorizations and verify patient benefits across a wide spectrum of insurance providers.
• Your responsibilities will extend to becoming our resident expert on how different payors operate, what documentation they mandate, and how their processes differ across various medical specialties. This investigative work is crucial for enabling our team to effectively support healthcare providers, ensuring that patients can access the timely and necessary care they require without undue administrative hurdles. This role is perfectly suited for someone who finds satisfaction in the investigative aspects of insurance administration, is committed to staying abreast of evolving payor policies, and aspires to develop unparalleled expertise across a broad array of insurance plans.
• Key responsibilities include meticulously researching and documenting prior authorization and benefit verification requirements for a diverse range of payors, encompassing commercial insurance plans, state Medicaid programs, and potentially others. You will delve into the intricacies of payor-specific submission processes, identifying critical elements such as required documentation, preferred submission portals, designated fax numbers, specific CPT code requirements, and any relevant policy updates that could impact the authorization or verification workflow.
• A significant part of your role will involve staying continuously informed about payor policy changes, with a particular focus on those that directly affect authorization processes and benefit structures. This requires a proactive approach to information gathering, utilizing payor websites, official newsletters, and direct communications with payor representatives to ensure the accuracy and currency of the information you collect.
• You will be expected to validate information gathered from multiple sources, critically assessing the credibility and reliability of payor guidance to ensure the highest level of accuracy in your findings. The ability to work independently to solve complex and ambiguous problems, especially in situations where established processes do not yet exist or are unclear, is paramount.
• Your findings will be instrumental in shaping our internal processes and supporting our operational teams. Therefore, clear and concise communication of your research outcomes to cross-functional stakeholders is essential. You must be adaptable and responsive to feedback, iterating on your findings and recommendations as needed.
• This role operates within a fast-paced startup environment, demanding the ability to handle tight deadlines and adapt quickly to shifting priorities. The dynamic nature of healthcare administration means that you will need to be flexible and resilient in the face of evolving challenges.
• Ultimately, your work will directly contribute to Silnahealth.Com's mission of transforming healthcare administration. By providing clear, actionable intelligence on payor requirements, you will empower healthcare providers to navigate the complexities of insurance more effectively, thereby improving patient access to care and enhancing the overall patient experience. This is an opportunity to make a tangible impact in a growing company that values innovation and dedication.

🎯 Requirements

• Prior authorization and/or insurance verification experience within a healthcare clinic setting.
• Deep familiarity with payor submission processes and an understanding of how requirements vary across different insurance plans.
• Strong research skills with demonstrated comfort navigating payor portals, websites, and official documentation.
• Exceptional attention to detail, with the ability to identify common authorization errors and discrepancies.
• Proven ability to work independently, solve complex problems, and improve processes in ambiguous or evolving environments.

🏖️ Benefits

• Competitive hourly pay rate of $25-$27 per hour.
• Fully remote work arrangement, offering flexibility and work-life balance.
• Provision of all necessary devices and system access to perform your role effectively.
• Opportunity to be part of a transformative healthcare startup and make a direct impact on patient care.

Skills & Technologies

Remote

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Silna Health

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About Silna Health

Silna Health is a healthcare technology company that builds cloud-native software for value-based care providers. Its platform automates administrative workflows, aggregates clinical and claims data, and delivers analytics to help medical groups, IPAs, and health plans improve quality outcomes, reduce costs, and manage risk-based contracts across Medicare Advantage, Medicaid, and commercial populations.

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