Job Description

• Process prior authorizations – Submit, track, and follow up on prior authorization requests for pain management services including injections (e.g., epidural steroid injections, nerve blocks), radiofrequency ablations, spinal procedures, imaging (MRI/CT), and specialty medications. Ensure all clinical documentation meets payer guidelines.

• Insurance verification and coordination – Verify patient benefits, coverage, and eligibility for pain management services. Coordinate with providers and clinical staff to collect necessary documentation such as office notes, imaging reports, and treatment plans.

• Maintain accurate records – Document all authorization activity, approvals, denials, and payer communication in the electronic medical record (EMR). Monitor authorization timelines to ensure procedures are not delayed.

• Resolve authorization issues – Follow up on pending or denied cases. Assist with appeals by gathering supporting documentation and working with providers and insurance representatives to secure approvals.
• Other duties: – Answer phones, communicate with patients regarding authorization status and scheduling readiness, and assist with front-office or administrative duties as needed. Maintain professionalism and support a fast-paced pain management practice environment.

• Minimum of 1 year of prior authorization experience required (pain management or specialty care preferred)
• High school diploma or equivalent
• Strong understanding of medical terminology, CPT/ICD-10 coding, and insurance authorization processes related to interventional pain procedures
• Excellent communication and organizational skills
• Ability to manage multiple authorizations and meet deadlines in a fast-paced setting
• Experience with EMR systems required