Prior Authorization Specialist

Prior Authorization Specialist

Boulder Care is an award-winning digital clinic for addiction medicine, recognized for both innovation and high quality of patient care. Founded in 2017 by CEO Stephanie Strong, our mission is to improve the lives of people with substance use disorders through compassionate, evidence-based care.

We provide Boulder patients with a fully virtual, multidisciplinary care team—including medical providers and peer recovery specialists—who deliver personalized treatment, including medication for opioid use disorder (MOUD) and ongoing support. Our approach is grounded in clinical excellence, patient-centered care, and a commitment to reducing barriers to recovery. Boulder partners with leading health plans, employers, and community organizations to ensure that our services are accessible and covered for the people who need them most.

Named by Fortune as one of the Best Workplaces in Healthcare, we foster a culture of kindness, respect, and meaningful work that delivers outstanding patient outcomes and moves the addiction medicine industry forward.

About the Role

The Prior Authorization Specialist is responsible for obtaining all pre-authorizations for medication approvals. They will work closely with staff to review, research and complete prior authorizations, prior authorization appeals, and notify patients of status updates from insurance. The most important goal is to improve patients' medication adherence by offering a quick and effortless way for patients to get their medications on time.

What You'll Do:

• Obtain prior-authorization for all patients requiring insurance approval for medication needs
• Verify patient insurance information is accurate and documented correctly
• Troubleshoot prior authorization submissions and prescription processing with health care providers utilizing phone or online resources
• Review and resolve all reported authorization issues timely and effectively
• Submit prior authorizations to insurance plans in a timely manner via payer-specific portals, fax, or verbally via phone
• Communicate authorization and benefit coverage with patients and providers promptly and professionally
• Obtain appropriate documentation to validate the approval or denial of authorizations
• Document progress of prior authorization appropriately using our operating system
• Follow up on pending authorizations on a regular basis to obtain the current status or to be informed of any action needed in order to obtain the authorization approval
• Successfully navigate between multiple systems throughout the course of the workday, this includes but is not limited to operational software and payer portals
• Maintain patient file security and confidentiality by adhering to appropriate confidentiality and HIPAA policies and guidelines
• Advise management of identified trends with payers in an effort to mitigate problems

What You Bring:

• A minimum of 6 months of experience working on prior authorizations
• 2+ years of Medical office/clinic experience
• Ability to organize workload and manage time effectively
• Technologically savvy
• Ability to read and interpret medical benefits for verification requests
• Ability to handle a high volume of work with speed and accuracy
• Passion for helping people
• Ability to work closely with our care team to ensure the success of patients that are recommended to us by their physician's office
• Team player that can also solve problems independently
• Exceptional written and verbal communication skills
• Reliable, and a self-starter
• Access to reliable, high-speed internet to meet the needs of remote processing

Nice to Haves:

• Medical Assistant experience
• Customer service experience
• Remote/telehealth experience
• A passion for serving the needs of people with addiction and mental health challenges, using non-stigmatizing, non-judgmental person-first language

Work Environment

• This is a fully remote role but we are currently only hiring candidates located in the following states: AZ, FL, GA, ID, IL, KY, MA, NC, NJ, NV, NY, OH, OR, PA, SC, TN, TX, UT, WA, and WV
• Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.
• Office Requirements: Boulder teammates working with sensitive information must have a dedicated, private workspace with a lockable door and high-speed internet to maintain a secure, distraction-free environment, ensuring compliance with HIPAA and confidentiality standards
• Boulder Care employees are free to use our river-front HQ located in Portland, OR whenever they would like

Expected Hours of Work

This is a full-time position expected to work 40 hours a week, M-F. Team members are asked to work a 9-hour shift which includes an hour-long lunch break. Shift will need to fall within the hours of 8am - 6pm Mountain / Pacific Time.

Hiring Process

• Video Panel Interview (1-hour)
• Start Date - Based on candidate availability and team needs

Compensation

The starting pay range for this position is $23 - $25/hr; base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including equity grants in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave).

Some of Boulder's Amazing Benefits for Regular, Full-Time Employees

• Contribute to meaningful, life-saving work!
• Comprehensive medical, dental, vision, and short-term disability benefits designed to take care of our employees and their families
• Mental Health Services via insurance coverage including Talkspace and EAP for continuous care
• 4 weeks of vacation accrued per calendar year with a tenured increase to 5 weeks at 2 years of employment
• Sick leave accrued at 1 hr for every 30 hrs paid
• 9 Paid Holidays per year
• 12 weeks of 100% paid parental leave for the birth or adoption of a child (after 6 months of employment)
• 401(k) retirement savings

Our Values

• Patients always come first
• Our opportunity is also our duty
• Move the industry forward, follow the data
• Facts to change minds, empathy to change hearts
• Turn bold ideas into even bolder action
• Strong individuals, stronger together
• Boulder Care recognizes the value that lived experience can provide to our organization, community, and patients. Applicants with lived experience and/or training as a peer recovery specialist are encouraged to apply.

Boulder Care believes the people who manage our product and team should be representative of those who use the platform. This includes people from backgrounds that are historically underrepresented in the industry. We celebrate differences and are committed to equal employment opportunities regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, citizenship, marital status, disability, gender identity or veteran status. If you are a qualified person with a passion for what we do, please apply!