Authorization Specialist - Pain Management

About Us:

Groth Pain and Spine is Long Island's number one pain management practice because we value our team and treat everyone as valuable individuals. We have high standards and expect a great work ethic with patient centered values. We believe in going the extra mile for the patients we serve and the people who work for us! As a more modern practice we focus on teamwork, collaboration, and proactive problem solving so that we are always ahead of the game and building together. 

About the Role:

The Authorization Specialist - Pain Management plays a critical role in ensuring that patients receive timely and appropriate access to pain management treatments by efficiently managing insurance authorizations and approvals. This position involves close collaboration with healthcare providers, insurance companies, and patients to navigate complex insurance requirements and expedite the authorization process. The specialist will be responsible for verifying patient insurance benefits, submitting prior authorization requests, and following up on pending approvals to minimize delays in care. By maintaining accurate records and staying current with insurance policies and pain management protocols, the specialist helps optimize patient outcomes and supports the clinical team’s ability to deliver effective pain management solutions. Ultimately, this role contributes to the seamless coordination of care and enhances patient satisfaction by reducing administrative barriers to treatment.

Minimum Qualifications:

• High school diploma or equivalent; Associate’s degree or higher preferred.
• Minimum of 2 years experience in medical insurance authorization, preferably within pain management or related healthcare fields.
• Must Understand No Fault and Workers Comp
• Strong knowledge of insurance plans, prior authorization processes, and medical terminology related to pain management.
• Proficiency with electronic health records (EHR) systems and insurance portals.
• Excellent communication and organizational skills.

Preferred Qualifications:

• Bachelor’s degree in healthcare administration, nursing, or related field.
• Experience working specifically with pain management clinics or departments.
• Familiarity with coding systems such as CPT, ICD-10, and HCPCS related to pain management services.
• Certification in medical billing, coding, or healthcare administration.
• Demonstrated ability to manage multiple authorization requests efficiently in a fast-paced environment.

Responsibilities:

• Review and verify patient insurance coverage and benefits related to pain management services.
• Prepare, submit, and track prior authorization requests for medications, procedures, and therapies specific to pain management.
• Communicate effectively with insurance companies to resolve denials, appeals, and requests for additional information.
• Collaborate with healthcare providers and clinical staff to gather necessary documentation and ensure compliance with payer requirements.
• Maintain detailed records of authorization requests, approvals, denials, and appeals to support audit readiness and reporting.
• Educate patients and providers on insurance policies and authorization processes to facilitate understanding and compliance.
• Monitor changes in insurance policies and pain management regulations to update internal procedures accordingly.

Skills:

The Authorization Specialist utilizes strong communication skills daily to interact with insurance representatives, healthcare providers, and patients, ensuring clear and effective information exchange. Analytical skills are essential for reviewing insurance policies, interpreting medical documentation, and identifying the correct authorization pathways. Organizational skills are critical for managing multiple concurrent authorization requests, tracking their status, and maintaining accurate records to support compliance and reporting. Proficiency with electronic health records and insurance portals enables the specialist to submit and monitor requests efficiently, reducing turnaround times. Additionally, problem-solving skills are frequently applied to address denials or incomplete information, facilitating appeals and ensuring patients receive necessary pain management treatments without unnecessary delays.