Prior Authorization Specialist (Buenos Aires)

Buenos Aires
Permanente
Tiempo completo

Hace 1 día

Industry\nHealthcare / HealthTech / Revenue Cycle Management (RCM)\nWork Arrangement\nRemote\nJob Type\nFull-Time\nWork Schedule\nShift aligned with US EST/PST (to support US provider practices)\nLocations\nRemote – Global (must overlap with US working hours)\nAbout Pearl Talent\nPearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund. They’re looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we’ve hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US.\nHear why we exist, what we believe in, and who we’re building for: WATCH HERE)\nWhy Work with Us?\nAt Pearl, we’re not just another recruiting firm—we connect you with exceptional opportunities to work alongside visionary US and EU founders. Our focus is on placing you in roles where you can grow, be challenged, and build long-term, meaningful careers.\nAbout the Company\nOur client is a fast-growing healthcare operations company modernizing ophthalmology Revenue Cycle Management (RCM). They focus on improving prior authorization workflows, reducing administrative burden for provider practices, and leveraging technology and automation to streamline complex insurance approval processes. The company operates at the intersection of healthcare operations and software innovation, building systems that improve patient access to critical procedures.\nRole Overview\nWe are seeking a highly experienced Prior Authorization Specialist to support complex ophthalmology cases within a high-growth healthcare operations environment. This role functions as a clinical escalation expert, handling high-complexity insurance authorizations, appeals, and medical necessity reviews for surgical and specialty procedures.\nYou will serve as a key link between clinical workflows, US-based provider practices, and internal product/engineering teams, helping translate real-world authorization challenges into scalable system improvements. This is not a traditional back-office role—this is a high-ownership, problem-solving position where you will actively shape workflows and automation design.\nThe adecuado candidate thrives in ambiguous, fast-moving environments, has deep expertise in US payer systems, and is comfortable making judgment calls on complex clinical documentation requirements.\nYour Impact:\n\n
- You will ensure timely and accurate approvals for high-complexity ophthalmology procedures, directly impacting patient access to care.
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- You will reduce authorization delays and denial rates by strengthening documentation quality and review processes.
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- You will help identify automation opportunities that improve operational efficiency and reduce manual workload across the RCM function.
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- You will contribute to continuous workflow improvement by translating real payer behavior into scalable process logic.
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- You will elevate team quality by mentoring junior staff and establishing best practices for complex case handling.
\n\nCore Responsibilities\nAdvanced Authorization Case Management – 40%\n\n
- Manage end-to-end prior authorization processes for complex ophthalmology procedures.
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- Review clinical documentation to ensure medical necessity compliance (e.g., imaging, test results, physician notes).
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- Submit and manage appeals, reconsiderations, and payer follow-ups for denied cases.
\n\nClinical QA & Team Escalation Support – 25%\n\n
- Act as escalation point for complex authorization cases from junior eligibility staff.
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- Conduct case audits to identify errors, gaps, and training opportunities.
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- Develop and maintain internal payer and policy knowledge documentation.
\n\nWorkflow Optimization & Product Collaboration – 20%\n\n
- Collaborate with US-based product and engineering teams to map authorization workflows.
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- Identify automation opportunities and define logic for system improvements.
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- Report workflow failures, edge cases, and payer-specific exceptions.
\n\nStakeholder & Provider Coordination – 15%\n\n
- Communicate with US provider offices to resolve missing documentation issues.
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- Coordinate across teams to ensure timely

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