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