Prior Authorization Specialist

Job Description

Job Description

Aston Carter is hiring for Patient Access and Prior Authorization Specialists!

** if you are interested in this opportunity, please feel free to apply and email me your resume at vsosa @ astoncarter.com so we can schedule a time to connect asap! **

Job Description

This role serves as a next-generation contact center position in the healthcare field, acting as the human-in-the-loop between AI-led conversations and traditional insurance verification. You will monitor and guide AI-driven calls between healthcare representatives and insurance agents, step in when human interaction is required, and ensure that all insurance verification and prior authorization details are accurately documented. By supporting and training the AI system through real-time interactions, you help streamline access, adherence, and affordability for patients across the healthcare reimbursement landscape.

Responsibilities

• Monitor AI-led agent-to-agent conversations between healthcare representatives and insurance agents to ensure accuracy and continuity.
• Guide AI interactions by selecting appropriate prompts, responses, questions, and next steps during live calls.
• Take over calls when the AI cannot respond to an agent’s question, when an agent prefers to speak with a human, or when a carrier or contract requires human interaction.
• Review notes from existing conversations and quickly pick up where another specialist or the AI left off to maintain a seamless experience.
• Conduct insurance verification by confirming eligibility, benefits, and coverage details with insurance agents.
• Gather and document prior authorization information and perform related follow-up activities as needed.
• Capture complete and accurate information before concluding each call or interaction.
• Maintain detailed notes during and after conversations, ensuring all insurance verification and authorization information is properly recorded.
• Update internal systems with all relevant details from each interaction and verify that information is complete and accurate before closing out the case.
• Manage both outbound and inbound call workflows while consistently maintaining quality, accuracy, and professionalism.
• Use AI tools, multiple computer systems, and screens simultaneously to support efficient call handling and documentation.
• Follow established processes, scripts, and workflows while remaining solution-oriented and focused on resolving issues.
• Collaborate with AI-driven technology by providing clear, accurate inputs that help improve system performance over time.
• Demonstrate strong listening, comprehension, and communication skills to build rapport with insurance agents and other stakeholders.
• Absorb information quickly from previous notes, understand the status of ongoing interactions, and continue conversations without missing critical details.
• Continuously adapt to new technology, workflows, and process improvements to enhance patient access and coordination of care.

Essential Skills

• High School Diploma or GED.
• Basic computer proficiency and the ability to learn new systems and tools.
• Proven data entry and documentation skills with strong attention to detail.
• Experience navigating multiple systems and screens simultaneously.
• Customer service experience (at least 6 months) in a call center, customer support, or similar environment.
• Strong listening, comprehension, and verbal communication skills.
• Ability to provide a high level of customer service and professionalism in all interactions.
• Solution-oriented mindset with the ability to resolve issues and follow through.
• Ability to work independently while following directions and established processes.
• Capability to quickly absorb information from previous notes and continue conversations seamlessly.
• Coachable and adaptable to new technology, AI tools, and evolving workflows.
• Experience with call center operations, call monitoring, and call support.
• Proficiency in data entry management and administrative support tasks.
• Comfort working in healthcare-related environments, including insurance verification and prior authorization support.
• Familiarity with Microsoft Office or similar productivity tools.

Additional Skills & Qualifications

• Experience in healthcare administration or customer service, such as Healthcare Receptionist, Medical Office Assistant, Healthcare Call Center Representative, Patient Access Representative, Pharmacy Technician or Support, Medical Administrative Assistant, Healthcare Internship, or recent college graduate experience.
• Experience in customer care, client services, or client support roles.
• Front desk or administrative support experience in a healthcare or insurance setting.
• Exposure to process improvement initiatives within call centers or administrative environments.
• Understanding of healthcare insurance verification, benefits, eligibility, and prior authorization processes.
• Ability to manage both inbound and outbound call workflows while maintaining accuracy and quality.
• Comfort working alongside AI-driven technology and contributing to its continuous improvement.
• Strong organizational skills and the ability to manage detailed documentation across multiple systems.

Work Environment

This is a remote position based in the United States. Candidates must reside in one of the following states: Florida, North Carolina, Texas, Utah, South Carolina, Wisconsin, Georgia, Indiana, or Delaware.

This is a Contract to Hire position based out of San Francisco, CA.

The pay range for this position is $20.00 - $20.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Aug 21, 2026.

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence. With offices across the U.S., Canada, Asia Pacific and Europe, Aston Carter serves many of the Fortune 500. We are proud to be a ClearlyRated Best of Staffing® Platinum Award winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on ziprecruiter.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.