JOB OVERVIEW

DeliverHealth is seeking an experienced Prior Authorization (PA) Specialist to support the continuous improvement of InstaAuth, DeliverHealth's AI-powered and agentic Prior Authorization platform.

The primary responsibility of this role is to evaluate the quality, accuracy, completeness, and efficiency of the AI-driven Prior Authorization workflows executed by InstaAuth. The specialist will review AI-generated prior authorization requests, validate clinical documentation and payer requirements, identify workflow failures, false approvals, false denials, missing information, and automation gaps, and provide structured feedback to Product Management, AI Engineering, and R&D; teams.

This is not an operational Prior Authorization processing role responsible for submitting authorizations on behalf of providers. Instead, this is a Product Quality and Clinical AI role focused on continuously improving the intelligence, reliability, and automation capabilities of the InstaAuth platform.

The role serves as the bridge between Prior Authorization operations, payer requirements,



clinical documentation, revenue cycle management, and AI product development.

JOB DUTIES & RESPONSIBILITIES

1. VALIDATE AI-DRIVEN PRIOR AUTHORIZATION WORKFLOWS

REVIEW END-TO-END PRIOR AUTHORIZATION WORKFLOWS EXECUTED BY INSTAAUTH TO DETERMINE WHETHER THE AI:

* CORRECTLY IDENTIFIED PROCEDURES REQUIRING PRIOR AUTHORIZATION.

* SELECTED THE APPROPRIATE PAYER-SPECIFIC WORKFLOW.

* COLLECTED ALL REQUIRED CLINICAL DOCUMENTATION.

* RETRIEVED THE CORRECT PAYER CRITERIA AND MEDICAL POLICIES.

* COMPLETED AUTHORIZATION FORMS ACCURATELY.

* IDENTIFIED MISSING CLINICAL INFORMATION.

* APPLIED PAYER RULES CORRECTLY.

* GENERATED APPROPRIATE CLINICAL JUSTIFICATION.

* ROUTED CASES TO THE CORRECT WORKFLOW.

* RECOMMENDED THE APPROPRIATE NEXT ACTION.

ASSESS WHETHER EACH WORKFLOW IS:

* ACCURATE

* COMPLETE

* CLINICALLY APPROPRIATE

* COMPLIANT WITH PAYER REQUIREMENTS

* READY FOR SUBMISSION

* OP

📌 Prior Authorization Specialist (India)
🏢 Deliverhealth Solutions
📍 India