Medicare Authorization Consultant

Job Summary

A company is looking for a Medicare Prior Authorization Consultant to support healthcare operations remotely.

Key Responsibilities

• Provide expert-level consultation on Medicare Advantage prior authorization operations
• Guide the development and implementation of scalable prior authorization programs
• Ensure alignment with CMS regulations and optimize authorization workflows

Qualifications and Skills

• 7+ years of Medicare Advantage prior authorization experience
• In-depth knowledge of CMS policies and Medicare Administrative Contractor (MAC) operations
• Experience managing high-volume prior authorization programs (10,000+ annually)
• Familiarity with clinical criteria review and medical necessity evaluation
• Advanced degree (MHA, MPH, MBA) or healthcare certifications (CHC, CHPC) preferred