Prior Authorization Associate - Remote US

Gainwell Technologies LLC

2d•Remote

About The Position

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. SummaryThe Prior Authorization Associate supports healthcare operations by performing back-office prior authorization (PA) review and decisioning activities. This role is primarily analytical and documentation-focused, applying established policy and program criteria to ensure accurate and timely determinations. While limited provider interaction may occur, this position is not a high-volume inbound call center role.Your role in our mission Support state healthcare programs by accurately reviewing and processing prior authorization requests in accordance with established policies and timelines Help ensure members receive appropriate, timely access to care through consistent and well-documented decisioning Contribute to the integrity of healthcare operations by maintaining accurate records and adhering to regulatory and compliance standards Collaborate with internal teams to resolve authorization-related inquiries and improve operational workflows Uphold Gainwell’s commitment to service excellence, accountability, and quality in delivering critical healthcare support services What we're looking for At least 2 years of experience in healthcare operations such as prior authorization, utilization management, claims processing, provider services, or related administrative healthcare roles Experience interpreting and applying healthcare policies, procedures, or regulatory guidance Strong written communication skills with the ability to clearly document decisions and outcomes High attention to detail with the ability to balance accuracy, quality, and productivity Ability to work independently in a remote environment while collaborating effectively with internal teams What you should expect in this role A 100% remote role requiring a reliable high-speed internet connection (minimum 24 Mbps download / 8 Mbps upload) A back-office, analytical work environment focused on prior authorization review, documentation, and decisioning Limited phone interaction compared to traditional call center positions Frequent use of multiple systems to review requests, apply criteria, and document outcomes A comprehensive Gainwell benefits package including medical, dental, and vision coverage, 401(k) with company match, paid time off, paid holidays, floating holidays, and employee wellness programs

Requirements

At least 2 years of experience in healthcare operations such as prior authorization, utilization management, claims processing, provider services, or related administrative healthcare roles
Experience interpreting and applying healthcare policies, procedures, or regulatory guidance
Strong written communication skills with the ability to clearly document decisions and outcomes
High attention to detail with the ability to balance accuracy, quality, and productivity
Ability to work independently in a remote environment while collaborating effectively with internal teams

Responsibilities

Support state healthcare programs by accurately reviewing and processing prior authorization requests in accordance with established policies and timelines
Help ensure members receive appropriate, timely access to care through consistent and well-documented decisioning
Contribute to the integrity of healthcare operations by maintaining accurate records and adhering to regulatory and compliance standards
Collaborate with internal teams to resolve authorization-related inquiries and improve operational workflows
Uphold Gainwell’s commitment to service excellence, accountability, and quality in delivering critical healthcare support services