Prior Authorization Specialist

Job Summary

A company is looking for a Prior Authorization Specialist (Contract).

Key Responsibilities

• Manage prior authorizations for pain management and orthopedic procedures and prescription medications
• Verify insurance eligibility and benefits, and review provider documentation for medical necessity
• Maintain documentation within EHR and tracking systems, and support billing and reconciliation activities

Required Qualifications

• 3+ years of prior authorization experience in Pain Management or Orthopedics
• Experience with interventional pain and orthopedic surgical authorizations
• Ability to independently manage high daily authorization volume
• Hands-on experience with payer portals and strong knowledge of CPT codes
• Experience reviewing documentation for medical necessity