--- title: 'Prior Authorization Specialist at Claim Health' canonical: 'https://feeny.ai/job/prior-authorization-specialist-claim-health-new-york-znms31e2h37c' type: 'job' last_seen: '2026-09-09' --- # Prior Authorization Specialist at Claim Health - **Company:** Claim Health - **Location:** New York, NY - **Employment:** full-time - **Work type:** onsite - **Posted:** 2026-07-18 - **Last confirmed live:** 2026-09-09 - **Apply:** https://jobs.ashbyhq.com/claim-health/582a7fac-d87d-4c96-ab7d-7681475cb59b ## Job description ## ABOUT THE ROLE We're hiring an experienced Prior Authorization Specialist to help build the future of authorization automation for home health and hospice. Prior authorization is one of the largest operational bottlenecks for agencies. Our platform automatically verifies benefits, gathers documentation, submits authorizations, follows up with payers, and monitors approval status. Your role is to ensure those automations run accurately, efficiently, and according to payer requirements. You'll combine deep operational knowledge with process improvement, helping us encode payer-specific workflows into software that scales across thousands of authorization requests. This isn't a traditional authorization desk role. It's an operations role for someone who understands the complexity of authorizations and wants to help automate them. ## WHAT YOU'LL DO ## AUDIT AUTHORIZATION WORKFLOWS Review authorization requests completed by our automations for completeness, accuracy, and turnaround time. Identify recurring failure points and determine whether issues stem from payer requirements, documentation, or automation logic. ## IMPROVE AUTHORIZATION AUTOMATION Partner with product and engineering teams to translate complex payer rules into scalable workflows. Help define escalation logic, documentation requirements, follow-up cadences, and exception handling. ## BUILD PAYER PLAYBOOKS Create and maintain SOPs covering authorization workflows across Medicare Advantage, Medicaid, managed Medicaid, commercial payers, and state-specific requirements. ## PARTNER WITH CLIENTS Meet with intake, authorization, and billing teams to understand agency workflows, resolve escalations, and configure automation to match operational needs. ## TRACK OPERATIONAL PERFORMANCE Monitor authorization turnaround times, approval rates, denial trends, escalation volume, payer response times, and automation success metrics. Drive continuous improvement initiatives. ## WHAT WE'RE LOOKING FOR ## REQUIRED - 3+ years of prior authorization experience within home health, hospice, or post-acute care - Deep familiarity with Medicare Advantage, Medicaid, managed Medicaid, commercial insurance, and authorization workflows - Experience obtaining authorizations across multiple payer portals - Strong understanding of eligibility verification, authorization documentation requirements, and referral workflows - Experience with HomeCare HomeBase (HCHB), Axxess, WellSky, and KanTime preferred - Strong organizational skills with excellent attention to detail - Experience documenting workflows or SOPs - Comfortable working independently in a fast-moving startup ## NICE TO HAVE - RN, LPN, or clinical background - Experience with Careport, Forcura, Ensocare, or referral management platforms - Experience working with automation or RCM software vendors - Knowledge of hospice-specific authorization requirements and Medicaid room & board processes ## WHY THIS ROLE Multiply your impact. Your expertise becomes automation that processes thousands of authorizations every month. Solve hard operational problems. Help eliminate one of the biggest administrative burdens in post-acute care. Build the future. Join an early-stage healthcare AI company where your knowledge directly shapes the product roadmap. ## About Claim Health ## Company Overview - **One-liner**: Claim Health is an AI revenue platform for post-acute care that automates revenue operations end-to-end — from referral intake through cash resolution. - **Entity Type**: Private (YC Spring 2025 batch, seed-stage startup) - **Headquarters**: New York, New York, United States - **Founded**: 2025 - **Founders**: Kevin Calcado (Co-Founder & CEO) and Jayen Ram (Co-Founder) ## Core Business - **Primary industry**: Healthcare IT / Revenue Cycle Management (RCM) for post-acute care (home health, hospice, home-based care) - **Target customers**: B2B, serving home-based care agencies, operators, and billing teams - **Mission/purpose**: Build the operational infrastructure home-based care deserves — preventing revenue leakage, automating administrative burden, and giving teams real-time visibility so they can focus on delivering care. ## Products & Services All offerings are AI-powered SaaS modules on a single platform: - **[Authorization Autopilot](https://www.claimhealth.com/)**: Automates prior authorizations from submission through renewal, continuously tracking approvals and alerting teams only to exceptions. - **[Smart Intake](https://www.claimhealth.com/)**: Centralizes referrals from fax, email, and portals; automatically extracts data, verifies eligibility, and routes accepted cases. - **[Billing Operations](https://www.claimhealth.com/)**: Post-submission workflows including payment posting, reconciliation, denial handling, and prioritized follow-up. - **[Revenue Assurance](https://www.claimhealth.com/)**: Identifies upstream data, documentation, and coverage risk inside the EMR before claims are submitted. - **[Platform Intelligence](https://www.claimhealth.com/)**: Real-time, end-to-end dashboard showing revenue risk, performance, and impact across the entire organization. ## Market Standing - **Valuation**: Not disclosed - **Total Funding**: $5,025,000 across three rounds (seed rounds) - Seed Round (May 2025): $125,000 from Y Combinator - Pre-Seed Round (July 2025): $500,000 led by Y Combinator - Seed Round (January 2026): $4,400,000 led by Maverick Ventures; other investors include Peak XV Partners, DHVP, and Y Combinator - **Notable Investors/Partners**: Y Combinator, Maverick Ventures, Peak XV Partners, DHVP; partners with national home care associations - **Growth Signals**: Headcount grew 350% YoY to 9 employees (as of mid-2026); active job postings up 150% quarterly; early customers report measurable results (3% EBITDA lift, 15% reduction in manual hours, 80% of claims auto-processed) ## Competitive Advantages - **Niche focus** on post-acute care (a $400B market with $20B+ annual revenue leakage due to broken infrastructure) - **End-to-end automation** — from intake through cash resolution, not just a point solution - **Proven early traction** with real‑world metrics (e.g., turned a 3‑day billing process into 2 hours, found six figures in lost revenue) - **Strong investor backing** from Y Combinator, Maverick Ventures, and other top-tier VCs - **Enterprise‑grade security** (HIPAA compliant, SOC 2 certified) ## Strategic Focus - Continue expanding platform capabilities to cover the full revenue cycle for home‑based care - Reduce manual intervention further — aiming for “medical billing as a one‑click process” - Enable agencies to scale without adding headcount through AI-driven automation and real‑time revenue risk detection ## Why Work Here - **Mission‑driven**: The company is building critical infrastructure for an underserved but vital part of healthcare — home‑based care - **Early‑stage impact**: With only 6–9 people (YC batch size), new hires can shape product, culture, and engineering decisions from the ground up - **Location & flexibility**: Based in New York, NY; job postings mention New York City and “any (new grads ok)” — likely hybrid or in‑office with some flexibility - **Engineering culture**: Co‑founder Jayen Ram is a 4‑time startup engineer; the team values removing burden from healthcare workers through smart automation - **Open roles** (as of mid‑2026): Full Stack Engineer, Deployment Specialist, Operations Associate, Visual Design Intern, Content Marketing Intern — offering roles across engineering, operations, and design - **Compensation**: YC job listings indicate $150K–$220K for senior engineering and $70K–$100K for early‑career roles; equity likely included but not specified ## Sources 1. [claimhealth.com](https://www.claimhealth.com/) 2. [jobs.ashbyhq.com/claim-health](https://jobs.ashbyhq.com/claim-health) 3. [ycombinator.com/companies/claim-health](https://www.ycombinator.com/companies/claim-health) 4. [linkedin.com/company/claim-health](https://www.linkedin.com/company/claim-health) ## Other roles at Claim Health - [Clinical QA Nurse (RN)](https://feeny.ai/job/clinical-qa-nurse-rn-claim-health-new-york-3akq7rs1axx3) — New York, NY - [Content Marketing Intern](https://feeny.ai/job/content-marketing-intern-claim-health-new-york-4rdv47zs6s6a) — New York, NY - [Visual Design Intern](https://feeny.ai/job/visual-design-intern-claim-health-new-york-58rzrptjdtxz) — New York, NY - [Deployment Specialist](https://feeny.ai/job/deployment-specialist-claim-health-new-york-cnmvzjxqpt9z) — New York, NY - [Forward Deployed Engineer](https://feeny.ai/job/forward-deployed-engineer-claim-health-new-york-6ynhzhfkssk4) — New York, NY - [Full Stack Engineer](https://feeny.ai/job/full-stack-engineer-claim-health-new-york-adae3fnprz5a) — New York, NY - [Operations Associate](https://feeny.ai/job/operations-associate-claim-health-new-york-vs3j8tm4r9b5) — New York, NY - [Prior Authorization Specialist](https://feeny.ai/job/prior-authorization-specialist-phil-remote-bjht6e852g3c)