Senior Consultant – Prior-Authorization & Appeals Specialist
CapeStart · Remote
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Employer requisition: 10499
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Collected role description
We are seeking a Prior-Authorization & Appeals Specialist to build and operate an evidence-cited appeals capability that converts denied prior-authorizations and coverage decisions into recoverable revenue across both the medical and pharmacy benefit. This is a consulting/on-demand role supporting client engagements, with a strong emphasis on productizing the appeals process for repeatable use. The ideal candidate should be comfortable working directly from payer denial letters and patient records to build a defensible, tailored appeal. We are seeking a Prior-Authorization & Appeals Specialist to build and operate an evidence-cited appeals capability that converts denied prior-authorizations and coverage decisions into recoverable revenue across both the medical and pharmacy benefit. This is a consulting/on-demand role supporting client engagements, with a strong emphasis on productizing the appeals process for repeatable use. The ideal candidate should be comfortable working directly from payer denial letters and patient records to build a defensible, tailored appeal.
Collected minimum qualification
Degree in Life Sciences, Nursing, Pharmacy, Health Administration, or related field, with experience in payer operations, utilization management, or provider-side prior-authorization/appeals work.