Prior Authorization Specialist

Responsibilities

• Process prior authorizations – Submit, track, and follow up on prior authorization requests for pain management services including injections (e.g., epidural steroid injections, nerve blocks), radiofrequency ablations, spinal procedures, imaging (MRI/CT), and specialty medications.
• Ensure all clinical documentation meets payer guidelines.
• Insurance verification and coordination – Verify patient benefits, coverage, and eligibility for pain management services. Coordinate with providers and clinical staff to collect necessary documentation such as office notes, imaging reports, and treatment plans.
• Maintain accurate records – Document all authorization activity, approvals, denials, and payer communication in the electronic medical record (EMR).
• Monitor authorization timelines to ensure procedures are not delayed.
• Resolve authorization issues – Follow up on pending or denied cases. Assist with appeals by gathering supporting documentation and working with providers and insurance representatives to secure approvals.

Requirements

• Minimum of 1 year of prior authorization experience required (pain management or specialty care preferred)
• High school diploma or equivalent
• Strong understanding of medical terminology, CPT/ICD-10 coding, and insurance authorization processes related to interventional pain procedures
• Excellent communication and organizational skills
• Able to manage multiple authorizations and meet deadlines in a fast-paced setting
• Experience with EMR systems required
• Able to work effectively in a team while maintaining strict confidentiality