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Prior Authorization Specialist - Therapeutic Botox & Specialty Medications Comprehensive Pain & Neurology Center Murfreesboro, TN Job Details Full-time $20.00 - $22.22 an hour 3 days ago Benefits Disability insurance Health insurance Dental insurance 401(k) Paid time off Employee assistance program Vision insurance Employee discount Life insurance Qualifications HIPAA Medical scheduling High school diploma or GED Attention to detail Organizational skills Full Job Description The Prior Authorization Specialist is responsible for managing the end-to-end insurance authorization and medication coordination process for therapeutic Botox injections and other specialty medications. This position works closely with providers, patients, insurance companies, specialty pharmacies, and internal staff to ensure treatments are properly authorized, medications are obtained, and patients are ready for their scheduled appointments. Essential Duties and Responsibilities Review medical records and provider documentation to ensure clinical and insurance requirements are met for therapeutic Botox and other specialty medications. Review and submit prior authorization requests using accurate ICD-10, CPT, and HCPCS codes . Submit authorizations through payer portals, phone, fax, and other required methods. Verify patient eligibility, benefits, coverage, and insurance limitations. Determine whether treatment should be processed through the medical or pharmacy benefit . Determine the appropriate medication fulfillment method, including specialty pharmacy or Buy & Bill . Coordinate with specialty pharmacies regarding authorization, prescription requirements, shipment, and delivery. Purchase and coordinate Buy & Bill medications when required. Track pending, approved, denied, and appealed authorizations within the EHR and other tracking systems. Monitor authorization expiration dates and initiate renewals as needed. Research denied requests and claims and submit reconsiderations and appeals with supporting clinical documentation. Work with providers to obtain medical records, letters of medical necessity, and other documentation required for approval. Review upcoming schedules to ensure patients have the necessary authorization and Botox or other medication available prior to their appointments. Proactively identify and resolve authorization or medication issues that could delay treatment. Communicate with patients regarding authorization status, medication availability, and scheduling. Contact patients to schedule treatment once authorization and medication requirements have been completed. Maintain accurate and timely documentation of all authorization, insurance, medication, and patient communication activities. Maintain patient confidentiality and comply with HIPAA and organizational policies. Qualifications High school diploma or equivalent required; healthcare-related education preferred. Previous experience with prior authorizations, insurance verification, medical billing, specialty pharmacy, or healthcare reimbursement required. Experience with therapeutic Botox authorization strongly preferred. Familiarity with medical and pharmacy benefits and insurance payer requirements. Knowledge of ICD-10, CPT, and HCPCS coding . Experience using EHR systems and insurance payer portals. Strong organizational skills and attention to detail. Excellent written and verbal communication skills. Ability to manage multiple cases, deadlines, and payer requirements independently. Strong problem-solving skills and ability to follow cases through completion. Key Competencies The ideal candidate is organized, detail-oriented, proactive, dependable, and patient-focused , with the ability to effectively communicate with providers, patients, insurance companies, and specialty pharmacies. The candidate should be comfortable researching insurance requirements, resolving authorization issues, managing denials and appeals, and ensuring all necessary steps are completed before a patient's treatment appointment. Position Success Success in this role is demonstrated by efficiently managing the authorization process from initial request through approval, medication procurement, and scheduling , while minimizing treatment delays and ensuring patients have the appropriate authorization and medication available when needed.

Pay:

$20.00 - $22.22 per hour Expected hours: 40.0 per week

Benefits:

401(k) Dental insurance Disability insurance Employee assistance program Employee discount Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person