Preauthorization Specialist

About Us

• Join our busy, patient-focused orthopedic, spine, and pain management, dedicated to delivering high-quality care and improving patient outcomes. We value teamwork, clear communication, efficiency, and accountability.
• The
• Role: We’re seeking a detail-oriented Preauthorization Specialist to obtain and manage insurance authorizations for surgeries, interventional pain procedures, injections, imaging, EMG/NCS, physical therapy, and durable medical equipment. You’ll work closely with providers, schedulers, and billing to ensure timely care and minimize denials.
• Key
• Responsibilities:
• Obtain prior authorizations and notifications from commercial payers, Medicare, and Medicaid.
• Review clinical documentation and submit authorization requests per payer requirements.
• Verify pre-service requirements.
• Track and update authorization status in the EMR and practice management system.
• Communicate authorization status to facilities and staff.
• Collect and submit supporting clinical documentation; follow up on pending requests.
• Prepare and coordinate appeals and peer-to-peer reviews for denials.
• Maintain accurate, auditable records and suggest process improvements.

Qualifications

• High school diploma or GED required; healthcare-related certificate or associate degree preferred.
• 1+ years’ experience in prior authorizations, insurance verification, utilization review, or medical billing — experience in orthopedics, spine, or pain management preferred.
• Familiarity with payer portals, EMRs (e.g., Athena, Availity Humana Military, etc), and CPT/ICD-10 basics.
• Strong communication, organization, and multitasking skills.
• Professional phone etiquette and ability to work under deadlines.
• Bilingual skills a plus (specify language if applicable).

What We Offer

• Competitive salary (DOE)
• Medical, dental, and vision benefits
• Paid time off and holiday pay