Job Summary We are seeking an experienced and detail-oriented Prior Authorization Specialist with hands-on experience in pain management to join our team. The ideal candidate will have a strong understanding of insurance requirements, prior authorization processes, medical necessity documentation, and common procedures, medications, imaging studies, and treatments associated with pain management.

The Prior Authorization Specialist will be responsible for obtaining timely insurance approvals, coordinating with providers and clinical staff, communicating with insurance companies, and helping ensure patients receive necessary care without unnecessary delays. Responsibilities Obtain and manage prior authorizations for pain management procedures, medications, diagnostic testing, imaging, and other services. Review patient charts, clinical documentation, diagnosis codes, procedure codes, and treatment plans to determine authorization requirements. Submit authorization requests through insurance portals, fax, phone, or other payer-specific systems. Communicate with commercial insurance plans, Medicare, Medicaid, workers' compensation, and other payers as appropriate. Follow up on pending authorizations and maintain accurate documentation of authorization status, reference numbers, and expiration dates. Identify missing clinical documentation and coordinate with providers and clinical staff to obtain required information. Review insurance policies and medical necessity criteria to anticipate potential authorization issues. Assist with appeals, peer-to-peer requests, and reconsiderations when authorizations are denied. Track authorization deadlines and ensure approvals are obtained before scheduled procedures whenever possible. Communicate authorization status and requirements professionally with physicians, clinical staff, scheduling teams, and patients. Maintain organized records and protect patient confidentiality in accordance with HIPAA requirements. Stay current with payer-specific requirements, changing policies, and authorization guidelines affecting pain management services. Identify recurring authorization issues and communicate opportunities for improving workflow and reducing delays or denials. Qualifications Experience with prior authorizations involving pain management services is strongly preferred, including familiarity with: Epidural steroid injections Facet joint injections and medial branch blocks Radiofrequency ablation Spinal cord stimulation Proven experience in a medical office setting or healthcare environment, preferably with prior authorization responsibilities. Strong knowledge of health insurance policies, managed care processes, and insurance verification procedures. Familiarity with medical terminology, CPT coding, ICD-9/ICD-10 coding standards, and medical billing practices. Proficiency in Microsoft Office applications such as Word and Excel for documentation and reporting purposes. Experience working with electronic health records (EHR) or electronic medical records (EMR) systems; knowledge of EHR/EHR management is highly desirable. Excellent customer service skills with the ability to communicate clearly with patients, providers, insurance representatives, and internal teams. Understanding of clinical confidentiality policies and compliance requirements related to HIPAA regulations. Join our team as a Prior Authorization Specialist if you are passionate about improving healthcare processes through meticulous attention to detail, effective communication, and a deep understanding of medical billing and insurance procedures. Your dedication will directly impact patient satisfaction by ensuring timely access to necessary treatments while maintaining compliance with industry standards.

Pay:

$20.00 - $23.00 per hour

Benefits:

401(k) Dental insurance Disability insurance Life insurance Paid time off Vision insurance

Work Location:

In person