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
- 401(k) or retirement plan options
- Supportive team environment and opportunities for growth
How to Apply: Send your resume and brief cover letter to t.hough@orthoassociates.net with the subject line “Preauthorization Specialist — [Your Name]”. Equal Opportunity Employer.
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