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Role Description

This is a hands-on role for someone who thrives in high-volume operational environments and is comfortable balancing individual contribution with team support. You will continue to process prior authorizations directly—often at high volume—while also serving as a go-to resource for other Ascertain Assistants. Over time, this role will evolve into a hybrid operations + technology position as workflows become increasingly automated and integrated with Ascertain’s platform. This is not a traditional healthcare shift-based, desk role. It is an outcome-driven position that rewards ownership, judgment, and follow-through.

What You'll Do

• Play a critical role in our new AI-powered prior authorization solution.
• Collaborate directly with Ascertain leadership and product teams.
• Work closely with healthcare providers to reduce administrative burdens and streamline detailed workflows.
• Manually process authorizations and oversee automated submissions for office visit referrals, procedures, pharmaceuticals, and more.
• Review and verify insurance information and patient eligibility for prior authorizations for prescription medications.
• Work directly with insurance payers, PBMs, and pharmacy benefit plans.
• Interpret formularies, step therapy requirements, quantity limits, and coverage criteria.
• Communicate with healthcare providers to gather necessary medical documentation and information.
• Monitor and track authorization requests to ensure timely processing and resolution.
• Respond to inquiries from healthcare providers, patients, and insurance companies regarding authorization status.
• Maintain accurate records of authorization requests, approvals, and denials.
• Collaborate with internal teams to resolve authorization issues and improve process efficiency.
• Stay updated on insurance policies, regulations, and industry trends related to prior authorizations.

Qualifications

• 4+ years of experience with prior authorization and billing in multiple specialties, including 2+ years of direct pharmacy prior authorizations experience.
• Experience handling denials and the appeals and peer to peer process.
• Strong understanding of formularies, step therapy, and medication coverage policies.
• Familiarity working with different specialty pharmacies and online portals.
• Bonus if you have experience in client relationships.
• Hands-on leadership roles (e.g., Team Lead, Supervisor, or informal leadership), paired with a roll-up-your-sleeves approach.
• Engaging with C-suite executives.

What You'll Bring to the Table

• Detail-Oriented: Meticulous in your work, catching errors and ensuring every authorization is processed accurately the first time.
• Collaborative: Energized by working with others, building trust and communicating clearly with providers, teammates, and cross-functional stakeholders.
• Adaptable: Comfortable shifting between manual workflows and leveraging new AI-powered tools, adjusting quickly as processes evolve.
• Empathetic: Attuned to the needs of healthcare providers and patients, approaching each interaction with patience, professionalism, and understanding.
• Process-Driven: Motivated by structure and consistency, following established workflows while identifying opportunities for improvement.

Why Ascertain?

Your work will directly impact healthcare organizations and improve patient care. Join Ascertain in transforming healthcare with AI!