Eligibility, Benefits, & Prior Authorization Specialist

**Job Title: Eligibility, Benefits, \& Prior Authorization Specialist** Location: 100% Remote (Offshore) Employment Type: Full\-Time Contractor Compensation: $600\-$800 Hours: 40 hours/week, primarily EST business hours Reports to: Operations / Revenue Cycle Lead About Josi Health Josi Health is a fast\-growing, virtual\-first healthcare company dedicated to making neurodivergent care (including evaluations \& therapy) faster, more accessible, and stress\-free for families. We operate across 40\+ states, navigating a complex landscape of commercial insurance carriers and state Medicaid programs. Because our clinical model is virtual\-first, having bulletproof front\-end patient access and benefit structures is critical to preventing administrative delays and billing denials. About the Role We are seeking a highly analytical, detail\-obsessed Eligibility, Benefits, \& Prior Authorization Specialist who loves the investigative side of healthcare administration. In this role, you will not just perform data entry. You will act as an internal researcher and gatekeeper, digging into payor portals, insurance policy and benefits updates, and clinical guidelines to uncover the exact steps needed to secure prior authorizations and verify complex telehealth benefits. This role is a blend of high\-velocity queue management and deep\-dive policy research. You will review incoming clinical orders, cross\-reference them with payer requirements, clear daily scheduling queues, and build process playbooks where none exist. If you thrive on solving insurance puzzles, de\-escalating complex scheduling bottlenecks, and keeping clinical schedules perfectly authorized, you will excel here. Key Responsibilities 1\. Insurance Verification \& Telehealth Benefit Research * Verify active patient insurance coverage, deductibles, co\-pays, co\-insurance, and coordination of benefits (COB) across commercial plans * Conduct in\-depth research on payer\-specific policies regarding virtual care, remote developmental pediatrics, and psychological evaluations (CPT 90791, 96130, etc.) * Navigate payor websites, newsletters, and provider manuals to track and document shifting policy guidelines and billing modifiers across 40\+ states 2\. Order Verification \& Prior Authorization Management * Review incoming clinical diagnostic referrals and orders to ensure demographic, insurance, CPT, and ICD\-10 data are flawless * Initiate, track, and validate prior authorizations through clearinghouses (e.g., Availity, Waystar), insurance portals, and phone escalations * Ensure all authorizations are secured, confirmed accurate, and fully documented in the EMR before the close of business each day for upcoming clinics 3\. Ambiguity Resolution \& Playbook Creation * Act as the go\-to resource for clinical teams when a payer's prior\-authorization process is vague, contradictory, or unmapped * Validate conflicting information from multiple insuran