Prior Authorization Specialist Job Description Welcome to Orthopaedic Associates of Duluth, P.A. (OA)- where health meets happiness! Orthopaedic Associates has been serving the Northland community since 1969, providing comprehensive orthopedic and sports medicine healthcare. Our dedicated team of medical professionals offers a full spectrum of treatment and rehabilitation services aimed at restoring mobility and reducing pain, ensuring patients can return to their active lifestyles swiftly and safely. More importantly, we are locally owned and care about our employees and community. We are looking for a detail-oriented Prior Authorization Specialist to support our growing orthopedic practice. This position's hours are Monday - Friday, 8:00am - 4:30pm CT. This will report to our Duluth location.

Job Summary:

The Prior Authorization Specialist plays a vital role in helping patients access the orthopedic care they need by coordinating insurance authorizations for procedures, diagnostic imaging, injections, medications, DME, and other services. This position ensures authorization requirements are understood, requests are submitted accurately and timely, and patients can move forward with their care without unnecessary delays. This position will ensure all services are reimbursed within the organization and looks for ways to improve workflows, authorization outcomes, and overall patient experiences.

Essential Duties/Responsibilities:

Submit and manage prior authorization requests for orthopedic services, including imaging, injections, DME, medications, and surgical procedures. Review clinical documentation to ensure requirements for medical necessity and authorization are met. Learn and apply payer-specific requirements and guidelines. Monitor authorization requests from submission through final determination. Track authorization status, expiration dates, and required extensions. Communicate with insurance carriers, patients, providers, and internal teams regarding authorization status and requirements. Identify missing documentation and proactively work to prevent delays in patient care. Resubmit or appeal authorization requests when appropriate. Maintain accurate documentation in payer portals and the EMR. Prioritize work based on procedure dates, urgency, and patient needs. Collaborate with clinical and administrative teams to keep workflows moving efficiently. Understand payer requirements and educate team members on necessary workflows. Seek and identify opportunities to improve approval rates and reduce delays. Help develop workflows, training materials, and standard operating procedures. Coordinate peer-to-peer reviews between providers and insurance carriers. Audit authorization records and identifying denial trends.

Education and Experience:

HS Diploma or GED Required Associates Degree preferred Knowledge of CPT codes or coding experience preferred One year of office experience in a healthcare setting required. Prior authorization or healthcare experience is valuable, but we also recognize that the right candidate may bring transferable skills, strong attention to detail, excellent communication, and a willingness to learn.

Physical Requirements:

Prolonged periods of sitting at a desk and working on a computer. Must be able to lift 15 pounds at times. Join a Team Where Your Work Matters Every successful authorization represents a patient who can move one step closer to receiving the care they need. At Orthopaedic Associates of Duluth, you will have the opportunity to make a meaningful contribution to patient care while developing specialized knowledge that can grow into increased responsibility, leadership, and compensation. If you're looking for a position where you can learn, grow, be recognized for your contributions, and build a career—not simply hold a job—we'd love to hear from you.

Pay:

$19.93 - $29.46 per hour

Benefits:

401(k) Dental insurance Disability insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off

Work Location:

In person