We are seeking a proactive and detail-oriented individual to be a hands-on Prior Authorization (PA) processor and the primary point of contact for managing our outsourced vendor relationships. This role contributes directly to the completion of PA workflows while overseeing the training, quality assurance, and performance support of our outsourced PA workforce. The ideal candidate will be a Subject Matter Expert (SME) in PA processing with strong operational awareness and communication skills to ensure alignment between internal expectations and external execution.

This role also requires a level of technical fluency: the ability to work alongside developers, data scientists, and product owners to continuously improve tooling, workflows, and automation. Candidates should be comfortable speaking the “language” of both healthcare operations and technology, and able to apply excel formulas, querying, or automation tools to improve the efficiency of their own tasks and the broader PA process.

Key Attributes for Success:

• Clear communicator who can balance task execution with team alignment.
• Able to work both independently and collaboratively.
• Comfortable giving and receiving feedback in a performance-focused environment.
• Passionate about quality, efficiency, and patient access to care.

PA Processing Responsibilities (Individual Contributor):

• Complete Prior Authorization submissions, status checks, and resolution activities using specific systems and payer portals.
• Ensure accuracy, timeliness, and completeness of all PA tasks assigned.
• Adhere to HIPAA, compliance, and client confidentiality guidelines at all times.
• Participate in process testing or pilot workflows when needed to support operational initiatives.

Outsourced Vendor Management:

• Serve as the day-to-day liaison for our outsourced PA workforce, ensuring they meet performance expectations, quality standards, and contractual obligations.
• Support the scaling of workforce capacity by coordinating both the onboarding of new agents and the transition or offboarding of existing staff when adjustments are needed.
• Manage workforce changes with a focus on minimizing disruption to service levels and maintaining clear, consistent communication between internal teams and vendor partners.
• Review and manage access, credentials, and documentation during both ramp-up and ramp-down periods to ensure compliance and operational continuity.

Training & Quality Assurance:

• Train new outsourced agents using internal documentation, SOPs, and PA tools; lead refreshers or process update sessions as needed to maintain knowledge consistency.
• Support knowledge retention and QA during periods of workforce reduction or transition, ensuring remaining staff are cross-trained and capable of absorbing workflow responsibilities as needed.
• Monitor quality and performance through routine audits and provide timely, actionable feedback in collaboration with the PA Operations Manager.
• Track and report on key QA and training metrics; escalate performance issues and workforce capacity concerns to leadership.

Process Optimization & Alignment:

• Help identify opportunities for workflow improvement across internal and outsourced teams.
• Ensure outsourced agents are aligned on evolving processes, documentation updates, and client expectations.
• Partner with internal teams (e.g., RPA, Product, Support) to surface operational gaps or inefficiencies flagged during processing or vendor coordination.

• Required:
  • 3+ years of hands-on experience in Prior Authorization processing or related healthcare operations.
  • Proven experience working with or supporting outsourced teams or vendors.
  • Demonstrated ability to support team scaling efforts, including onboarding, offboarding, and maintaining performance during periods of transition.
  • Strong understanding of PA requirements, payer policies, and workflow tools.
  • Strong communication, coordination, and documentation skills.
  • Detail-oriented, organized, and able to multitask in a fast-paced, remote environment.
• Preferred:
  • Experience in QA auditing or training in a healthcare or support services environment.
  • Familiarity with outsourced vendor oversight, workforce management, or contractor supervision.
  • Experience supporting process automation for workflows.

Work Environment:

• Fully remote within the U.S.
• Standard Monday-Friday business hours, with some flexibility based on team needs.
• Requires access to secure, high-speed internet and ability to work in a compliant home-office setting.

• Competitive compensation, with a base salary of $50,000-$60,000 (Exact compensation may vary based on skills and experience)
• Eligible for Company Performance-based Bonus Program, based on individual and company performance
• Medical, dental, and vision insurance
• 401K eligible after 3 months of employment, with 50% company match up to first 5% of salary contributed to the plan with a 3-year vesting schedule
• HSA for eligible employees enrolled in the HDHP, with a generous company contribution up to $500 for individual coverage and $1000 for family coverage per year
• 100% company paid short and long-term disability, AD&D, and group life insurance
• Accrued annual paid time off (PTO) of 18 days for the first 3 years of service, increasing thereafter and 7 paid holiday days
• Employee Assistance Program
• Continuing Education funds up to $1500 annually for eligible programs after 1 year of service
• Voluntary benefits including FSA, Hospital indemnity, Accident and Critical Illness insurances

DrFirst is committed to being a Remote-First company, creating a dynamic and flexible workplace where everyone can thrive, no matter where they log in from. Check out our approach to remote work https://drfirst.com/company/about-us/careers/.