Prior Authorization Specialist – Contract

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Job Description:

  • Ensure timely authorization approvals by managing the full lifecycle of prior authorization workflows
  • Submit and manage prior authorizations for pain management and orthopedic procedures
  • Manage prior authorizations and reauthorizations for medications used in pain management
  • Verify insurance eligibility and benefits prior to submission
  • Follow up on pending or denied authorizations
  • Maintain clear documentation within EHR and tracking systems

Requirements:

  • 3+ years of prior authorization experience in Pain Management or Orthopedics
  • Experience with interventional pain and/or orthopedic surgical authorizations
  • Prescription drug prior authorizations
  • Experience with clinic/provider side (not hospital/facility billing)
  • Ability to manage high daily authorization volume independently
  • Experience with payer portals (e.g., Availity, UHC, Carelon/AIM, eviCore, Cohere, CoverMyMeds, etc.)
  • Working knowledge of CPT codes and procedural terminology
  • Experience reviewing documentation for medical necessity
  • Exceptional attention to detail

Benefits:

  • Timely authorization approvals
  • High-volume authorization workflow management
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