Senior Prior Authorization Specialist

Join a High-Performing Specialty Care Team! Idaho Pain Clinic is seeking an experienced and highly motivated Senior Prior Authorization Specialist to lead and manage complex insurance authorization processes for specialty pain management services. This role is critical in ensuring timely patient access to care while supporting operational efficiency, provider productivity, and exceptional patient experiences. The ideal candidate brings advanced knowledge of insurance authorization workflows, strong problem-solving abilities, and the confidence to navigate complex payer requirements, appeals, and escalations. This individual serves as a resource to team members, demonstrates accountability and initiative, and contributes positively to a collaborative, patient-centered culture. This opportunity is ideal for experienced healthcare professionals in the Sandpoint, Coeur d'Alene, Post Falls, Spokane Valley, Liberty Lake, and greater Spokane region seeking long-term career growth within a respected specialty medical practice.

Key Responsibilities:

Manage and oversee complex prior authorizations for procedures, surgeries, injections, medications, imaging, and specialty treatments for both our Pain Clinic and ASC. Review payer requirements and ensure accurate, timely submission of authorization requests and supporting documentation. Proactively monitor pending authorizations and resolve issues to minimize delays in patient care and scheduling. Handle escalated denials, appeals, reconsiderations, and peer-to-peer review coordination with providers and insurance carriers. Serve as a subject matter resource for authorization processes, payer policies, and workflow best practices. Collaborate closely with providers, clinical teams, billing departments, and scheduling staff to support efficient operations and continuity of care. Identify workflow inefficiencies and contribute to process improvement initiatives that enhance patient access and operational performance. Maintain detailed, accurate documentation in EMR systems and payer portals. Ensure compliance with HIPAA regulations, payer guidelines, and clinic standards. Stay current on evolving insurance requirements, specialty care authorization trends, and regulatory changes. Provide support and mentorship to newer team members as needed.

Qualifications:

Minimum of 3-5 years of prior authorization, insurance verification, medical billing, or specialty healthcare administrative experience required. Strong understanding of commercial insurance, Medicare, Medicaid, and workers' compensation authorization processes. Experience managing complex specialty care or pain management authorizations strongly preferred. Knowledge of medical terminology, CPT/ICD-10 coding, and medical necessity documentation. Proficiency with EMR systems, insurance portals, and healthcare software platforms. Demonstrated ability to independently manage high-volume workloads and resolve complex payer issues. Excellent communication, organizational, and critical-thinking skills. Ability to maintain professionalism, empathy, and accuracy in a fast-paced clinical environment. Experience with AdvancedMD is a plus.

Preferred Experience:

Pain management, orthopedic, spine, neurology, or interventional specialty clinic experience. Experience with appeals management and peer-to-peer coordination. Leadership, training, or workflow improvement experience preferred. Bilingual candidates encouraged to apply. Why Idaho Pain Clinic? At Idaho Pain Clinic, we are committed to delivering exceptional patient care while building a culture grounded in professionalism, accountability, collaboration, and compassion. We value team members who take ownership of their work, strive for excellence, and contribute to a positive environment where both patients and employees can thrive. Our team proudly serves communities throughout North Idaho and Eastern Washington, including Sandpoint, Lewiston, Post Falls, Coeur d'Alene, Hayden, Spokane, Spokane Valley, Liberty Lake, and surrounding areas.

Pay:

From $22.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Employee discount Health insurance Paid time off Referral program Vision insurance

Work Location:

In person