• Competitive salary
• Dental insurance
• Health insurance
• Paid time off

Experienced Prior Authorization Specialist – Interventional Pain Management

• Obtain prior authorizations and pre-certifications for interventional pain procedures, diagnostic testing, medications, and other ordered services.
• Manage authorizations for procedures such as epidural steroid injections, medial branch blocks, radiofrequency ablation, sacroiliac joint injections, joint injections, nerve blocks, spinal cord stimulator trials and implants, and other pain-management treatments.
• Verify patient eligibility, benefits, coverage limitations, deductibles, co-insurance, referral requirements, and authorization requirements.
• Review provider orders and clinical documentation to confirm that payer-specific medical-necessity criteria are addressed before submission.
• Identify missing information and work with providers and clinical staff to obtain appropriate documentation.
• Submit accurate authorization requests through payer portals, by telephone, or through other required channels.
• Monitor pending requests and follow up proactively until a final determination is received.
• Track authorization numbers, approved service codes, dates of service, units, expiration dates, treatment limitations, and site-of-service requirements.
• Confirm that approved CPT and diagnosis codes match the services scheduled.
• Prevent avoidable denials by identifying coverage issues before procedures or treatments are scheduled.
• Review denials and determine the appropriate next step, including reconsideration, peer-to-peer review, corrected submission, or formal appeal.
• Prepare appeal packets using supporting clinical records, imaging reports, treatment histories, and letters of medical necessity.
• Coordinate peer-to-peer reviews between providers and insurance medical reviewers.
• Maintain accurate authorization notes and upload supporting documents into the electronic health record and practice-management system.
• Communicate authorization status, delays, denials, and coverage concerns clearly to patients and the appropriate internal team members.
• Work closely with scheduling, clinical, billing, and provider teams to support efficient patient care and clean claims.
• Protect patient confidentiality and comply with HIPAA, payer policies, and organizational procedures.
• Stay current on changing payer policies, medical-necessity guidelines, coding requirements, and authorization processes.
• Assist with authorization-related workflow improvements and denial-prevention initiatives.

• At least two years of prior authorization experience in a medical practice, surgery center, hospital, or specialty clinic.
• Direct experience obtaining authorizations for medical procedures, advanced imaging, specialty medications, or surgical services.
• Strong understanding of commercial insurance, Medicare, Medicaid, Medicare Advantage, and managed-care authorization processes.
• Experience using payer portals and communicating with insurance representatives.
• Working knowledge of CPT, ICD-10, HCPCS, and medical-necessity requirements.
• Ability to read and interpret clinical notes, imaging reports, treatment histories, and provider orders.
• Demonstrated experience following complex authorizations through approval, denial, reconsideration, or appeal.
• Excellent attention to detail, follow-through, organization, and time-management skills.
• Strong written and verbal communication skills.
• Ability to manage a high-volume workload while meeting deadlines and maintaining accuracy.
• Experience working with electronic health records and practice-management systems.
• Commitment to patient service, confidentiality, professionalism, and teamwork.

• Prior authorization experience in interventional pain management.
  
Experience with spine procedures and implantable pain therapies.

Familiarity with payer requirements for:

• • Epidural steroid injections
  • Facet joint procedures and medial branch blocks
  • Radiofrequency ablation
  • Sacroiliac joint injections
  • Peripheral nerve blocks
  • Spinal cord stimulator trials and implants
  • Intrathecal pain pump services
  • Advanced imaging
  • Specialty and controlled medications
• Experience preparing medical-necessity appeals and coordinating peer-to-peer reviews.
• Familiarity with Medicare local coverage requirements and commercial payer clinical policies.

• Submits complete, accurate requests the first time.
• Anticipates payer requirements instead of waiting for preventable denials.
• Follows pending cases consistently and communicates delays early.
• Understands the clinical purpose behind the services being authorized.
• Maintains precise records of approval details, deadlines, and payer communications.
• Advocates professionally and persistently for medically necessary patient care.
• Helps reduce authorization-related cancellations, delays, and claim denials.
• Treats patients with empathy, especially when insurance barriers create stress or uncertainty.
• Works collaboratively and remains calm in a fast-paced specialty environment.

• Competitive compensation based on experience
• Generous performance-based bonus opportunity
• Comprehensive health insurance
• Dental and vision coverage options
• Life insurance
• Paid time off
• Retirement plan with employer-supported options after the applicable eligibility period
• Professional development opportunities
• Flexible weekday scheduling
• No nights
• No weekends
• No holidays
• Supportive and collaborative team environment
• Meaningful work that improves patients’ access to care

• Your prior authorization experience
• The specialties and procedure types you have supported
• Your experience managing denials, appeals, and peer-to-peer reviews
• The insurance portals and electronic health record systems you have used