Insurance Authorization Specialist

Key Responsibilities

• Verify insurance eligibility and benefits for new and existing patients across multiple payers.
• Initiate, track, and follow up on prior authorization requests for interventional procedures, diagnostic imaging, and high-cost medications.
• Document payer responses and required authorization details accurately in the EHR (e.g., eClinicalWorks).
• Collaborate with clinical and scheduling teams to resolve coverage issues and reduce appointment delays.
• Communicate with insurance companies, pharmacies, and third-party vendors regarding approval status and documentation needs.
• Maintain organized records of all verification and authorization activity.
• Assist with insurance-related patient communication, including education on coverage limitations or denials.
• Stay up to date on payer policies relevant to pain management services and medications (e.g., epidurals, nerve blocks, spinal cord stimulators, controlled substances).
• Support appeals or peer-to-peer scheduling when denials occur.

Qualifications

• A high school diploma or equivalent required; an associate’s or healthcare certification preferred.
• 2+ years of insurance verification and/or prior authorization experience in a medical office (pain management preferred).
• Strong knowledge of commercial insurance, Medicare, Medicaid, and workers’ comp plans.
• Familiarity with CPT, ICD-10, and HCPCS codes.
• Experience with EHR systems (eClinicalWorks preferred).
• Ability to navigate payer portals and pre-certification platforms (Availity, AIM, CoverMyMeds, etc.).
• Excellent communication, documentation, and time management skills.
• Reliable internet and secure home workspace required.

Ideal Candidate Traits

• A self-starter who thrives with minimal supervision.
• Highly organized with strong attention to detail.
• Comfortable with change and fast-paced environments.
• Prior experience in pain management or specialty care is a major plus.