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AI Prior Authorization Automation Developer

Alice Rossi

Full-time · Job · New_York

About the role

Prior authorization is the process where doctors get insurer approval before providing treatments — and it delays care for 93 million patients per year according to AMA data. The average prior auth takes 2 days and 14 hours of physician staff time. Our automation platform completes 60% of prior authorizations in under 4 minutes by matching clinical documentation to payer criteria automatically. You'll build the clinical documentation matching pipeline: extracting structured clinical data from physician notes and lab results, mapping extracted findings to payer-specific medical necessity criteria, identifying documentation gaps that would lead to denials, and generating the clinical summary that accompanies the authorization request. Each decision point has regulatory implications — the system must be explainable and auditable. The health automation team is six engineers. You'll work alongside a clinical informaticist who validates medical necessity logic and a payer specialist who maintains the criteria databases for 200+ insurance plans.

Responsibilities

  • Build clinical documentation extraction for prior authorization requests
  • Map extracted clinical findings to payer-specific medical necessity criteria
  • Identify documentation gaps that would trigger authorization denials
  • Generate clinical summaries accompanying authorization requests
  • Ensure decision auditability for regulatory compliance
  • Maintain criteria accuracy across 200+ payer coverage policies

Requirements

  • 3+ years in NLP with healthcare or clinical documentation experience
  • Familiarity with healthcare data standards: FHIR, HL7, or clinical terminologies
  • Strong Python skills with LLM orchestration frameworks
  • Understanding of prior authorization workflows and medical necessity concepts
  • Comfort working in HIPAA-compliant development environments

Benefits

  • Fully remote with flexible hours
  • Comprehensive health coverage
  • 401(k) with 4% match
  • $3,000 annual conference fund
  • Work that directly reduces delays in patient care

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Categories

Automation & AI Workflows NLP & Prompt Engineering

Skills

python langchain openai api sql docker

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Job Type

Full-time

Level

Mid-Level

Language

English

Salary Range

$100k – $130k / year

AI Expertise

Automation & AI Workflows NLP & Prompt Engineering

Skills

python langchain openai api sql docker fastapi

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