Prior Authorization Specialist (Contract)

Role Overview

Flagler partners directly with pain management and orthopedic clinics to help optimize operations and improve financial performance. Prior authorizations are a critical component of that success. We are seeking a Prior Authorization Specialist (Contract) to support high-volume authorizations for both procedures and prescription medications.

What You’ll Be Doing

• Help ensure providers receive timely authorization approvals by managing the full lifecycle of prior authorization workflows.
• Submit and manage prior authorizations for pain management and orthopedic procedures, including:
• Epidural steroid injections
• Facet injections
• Radiofrequency ablation (RFA)
• SI joint injections
• Advanced imaging (MRI, CT)
• Orthopedic surgical procedures
• Manage prior authorizations and reauthorizations for medications commonly used in pain management.
• Navigate pharmacy benefit portals and step-therapy requirements.
• Submit formulary exception and medical necessity documentation when required.
• Authorization Management:
• Navigate multiple payer portals efficiently.
• Verify insurance eligibility and benefits prior to submission.
• Review provider documentation to confirm medical necessity and procedural alignment.
• Follow up on pending or denied authorizations.
• Identify documentation gaps before submission to reduce preventable denials.
• Maintain clear documentation within EHR and tracking systems.
• Support billing and reconciliation activities as needed, including resolving authorization-related billing issues.

Required Qualifications

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

Strongly Preferred Experience

• Experience with Medicaid plans, including AHCCCSCPC-A or other coding certification.
• Familiarity with NCCI edits, bundling rules, and step therapy protocols.
• Experience identifying recurring denial patterns and process gaps.