“My job is making sure pa submission + tracking — without anyone on your team having to ask.”
We watched our own healthcare admin team burn out on work that never stopped. Prior Authorization Specialists were leaving for better pay, calling out sick, and taking weeks to train — meanwhile the queue kept growing and customers kept waiting. There was no way to hire fast enough.
Rafael was built to be the piece of the team that's always there. Not a bot reading from a script, but a worker who knows the systems, the SOPs, and the judgment calls — so your senior people get their time back for the work only they can do.
Rafael in their own words.
I'm the prior authorization specialist your healthcare admin team leans on when the queue starts stacking. Works every PA from submission to approval. I own the work end-to-end — you hand me the inbox, the ticket, or the call, and it gets done right the first time.
Day to day I'm running pa submission + tracking, payer outreach, medical-necessity doc coordination. I know the systems your team uses, I know what "clean" looks like in this seat, and I don't drop details when the volume climbs.
I work inside your stack, not alongside it. Every action I take is logged, every handoff has context, and your senior people get their time back for the work only they can do.
Hear Rafael on a real call.
This is how Rafael handles a caller end-to-end — answer, capture, confirm, close. Request a demo to hear one live with your business.
Rafael is in production. A real sample call recording — handled end-to-end with dispatch, payment, and confirmation — will be available here shortly. Request a demo to hear one live with your business.
What Rafael does best.
Everything Rafael does, top to bottom.
These aren’t theoretical. Every item below is part of Rafael’s live SOP on real deployments.
- PA submission + tracking
- Payer outreach
- Medical-necessity doc coordination
- Denial appeal support
- Logs every action in your system of record
- Escalates with full context when scope is exceeded
- Runs against SOPs you approve before go-live
- Works inside your stack — no new tools required
How Rafael works a typical ticket.
Five steps, every time. Nothing skipped, nothing improvised.
Pick up the work
New prior authorization specialist work lands in my queue — form, ticket, email, or inbound request. I triage within minutes of arrival.
PA submission + tracking
PA submission + tracking. Done inside SOP, logged step-by-step, never skipped.
Payer outreach
Payer outreach. Done inside SOP, logged step-by-step, never skipped.
Medical
Medical-necessity doc coordination. Done inside SOP, logged step-by-step, never skipped.
Document + hand off
Every action lands in your healthcare admin system of record. If anything exceeds scope, I warm-transfer with full context — your team never starts from zero.
The tools Rafael works inside.
Rafael plugs into your existing stack. No new tools to learn, no data silos, no black box.
Built for the operators Rafael already works with.
Work Rafael has already done.
Every role below represents live deployments on real businesses — not theoretical capabilities.
- Primary prior authorization specialistEmbedded in healthcare admin teams
Works every PA from submission to approval.
- PA submission + trackingDaily workload
PA submission + tracking · Payer outreach · Medical-necessity doc coordination. Every action logged, every handoff documented.
- Cross-team coordinationInterfaces with healthcare admin stakeholders
Works alongside your existing team — never a black box. When scope exceeds the runbook, escalates with full context and proposed next step.
Real calls. Real tickets. Real outcomes.
Request came in via Slack at 9:12 AM. By 10:04 Rafael had processed the work, flagged one edge case to the team lead, and closed the loop with a short summary + links to the system of record.
Teams that already hired Rafael.
Challenge, solution, and the numbers that changed after go-live.
Physical Therapy operator missing prior authorization specialist work after hours. Senior staff pulled onto routine tasks; errors stacking up; customer follow-through slipping.
Deployed this worker on the primary pa submission + tracking flow. Loaded the SOP, wired the integrations, and flipped live inside 48 hours.
Growing behavioral health team could not hire fast enough to keep up with prior authorization specialist volume. Backlog grew 3x in 90 days; escalations ran hot.
Handed over the routine 80% of the queue. Senior staff kept the judgment calls. Every action logged in the system of record.
Rafael vs. hiring a human.
The math, laid out. No salary, no turnover, no sick days.
| Scenario | Human hire | Temp agency | Rafael |
|---|---|---|---|
| Annual cost | $45,000 | $65,250 | $4,188 |
| Hours covered | 40/week | 40/week | 168/week |
| Sick days | 10+/yr | 2+/yr | 0 |
| Ramp time | 6–8 weeks | 1–2 weeks | 48 hrs |
| Turnover risk | High | Very high | None |
Pick the bundle that fits your volume.
Buy minutes, not employees. Every plan includes full onboarding and integration. Upgrade or downgrade any month.
- 300 minutes / month
- $1.50/min overage
- One AI worker
- Standard SOP training
- Email support
- 500 minutes / month
- $1.50/min overage
- Custom SOP + voice training
- CRM / system-of-record integration
- Priority support
- Monthly tuning session
- 1,500+ minutes / month
- $1.50/min overage
- Multi-line / multi-region
- Custom voice + white-glove onboarding
- Dedicated CSM
- Per-team reporting
- SLA + BAA available
Need more volume? See all 14 tiers →
From signup to live in under 48 hours.
Four steps. We handle the technical work. You focus on the SOPs and the first-week review.
Pick your plan
Choose a minute bundle that matches your volume. Most prior authorization specialist ops start on the Starter or Pro tier.
Connect your inbox / ticket system
Hook into your CRM, help desk, or ticket queue. Webhooks or native integrations — we handle the plumbing.
Upload your knowledge
Scripts, SOPs, FAQs, rate cards — anything your prior authorization specialist team would hand a new hire. We train the worker on it.
Go live in under 48 hours
Soft-launch on a small % of traffic, review recordings the first week, then flip to full volume. You stay in control.
What teams say after they hire Rafael.
“Accurate, on-brand, and never calls out. We trust Rafael with work we'd only trust our most senior prior authorization specialists with.”
“Rafael caught errors our previous prior authorization specialist missed for months. The ROI was obvious inside two weeks.”
Everything teams ask before hiring Rafael.
Under 48 hours in most cases. We load your prior authorization specialist SOP, wire the integrations, and soft-launch on a small share of traffic so you can review before flipping to full volume.
Rafael warm-transfers (or routes the ticket) with a one-paragraph summary: what the caller / customer asked, what Rafael already confirmed, and why it's being escalated. Your team never starts from zero.
Whatever your team already uses. Rafael pushes actions into your existing healthcare admin stack — CRM, ticket system, calendar, SOR — via native integrations or webhooks. No new tool required.
You buy a minute bundle starting at $249/month. Every minute Rafael spends on your work counts toward the bundle. Overage is billed at $1.50/min. No seats, no per-call fees, no hidden add-ons.
Any time. Upgrades prorate instantly. Downgrades apply at the next billing cycle. Your worker keeps its training, voice, and history through any change.
Yes. Rafael works every shift, including weekends and holidays. Work that lands at 2 AM gets handled before your team walks in the next morning.
Every conversation is logged, encrypted at rest, and retained per your policy. For healthcare admin teams with HIPAA, PCI, or SOC2 requirements, we run on BAA-signed infrastructure with audit trails on every action.
Yes. Book a call with our team — we'll walk you through a live demo of Rafael, look at your current prior authorization specialist workflow, and map out what the first 30 days would look like.
Starting at $349/mo.
Live in under 48 hours.
Most teams run prior authorization specialists on the lite bundle or the next one up as volume grows.
