Prior Authorization Specialist – Contract
Job Description:
- Ensure timely authorization approvals by managing the full lifecycle of prior authorization workflows
- Submit and manage prior authorizations for pain management and orthopedic procedures
- Manage prior authorizations and reauthorizations for medications used in pain management
- Verify insurance eligibility and benefits prior to submission
- Follow up on pending or denied authorizations
- Maintain clear documentation within EHR and tracking systems
Requirements:
- 3+ years of prior authorization experience in Pain Management or Orthopedics
- Experience with interventional pain and/or orthopedic surgical authorizations
- Prescription drug prior authorizations
- Experience with clinic/provider side (not hospital/facility billing)
- Ability to manage high daily authorization volume independently
- Experience with payer portals (e.g., Availity, UHC, Carelon/AIM, eviCore, Cohere, CoverMyMeds, etc.)
- Working knowledge of CPT codes and procedural terminology
- Experience reviewing documentation for medical necessity
- Exceptional attention to detail
Benefits:
- Timely authorization approvals
- High-volume authorization workflow management