AI Prior Authorization Automation Developer

Lamion Solutions

Remote · $100k – $130k / year · Full-time · Posted 5 months ago

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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.

Fully remote.

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