Preauthorization Specialist

Nflsurgeons; Fort Walton Beach (FL); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

Paid time off and holiday pay

401(k) or retirement plan options

Supportive team environment and growth

Job summary

Nflsurgeons in Fort Walton Beach, FL seeks an Orthopedic/Spine Preauthorization Specialist to join our healthcare team. You will review preauthorization requests for orthopedic, imaging, surgery, pain management, spine procedures, DME, and PT, and coordinate with schedulers, providers, insurers, and patients to secure timely approvals.

Responsibilities include verifying coverage, gathering records, guiding providers on requirements, and maintaining detailed case documentation.

Qualifications

• 1+ years’ experience in prior authorizations, insurance verification, utilization review, or medical billing.
• Healthcare background in orthopedics, spine, or pain management preferred.
• High school diploma or GED; healthcare-related certificate/associate degree preferred.
• Familiarity with payer portals and EMRs (Athena, Availity Humana Military, etc.).
• Attention to detail; ability to analyze complex medical documentation.
• Strong written and verbal communication with healthcare providers, insurers, and patients.
• Proficient with EMR systems; HIPAA compliant.
• Bilingual skills a plus (Spanish/ASL).

Responsibilities

• Review and process preauthorization requests for orthopedic procedures and related services.
• Verify patient insurance coverage and eligibility for requested services.
• Collaborate with clinical staff to gather medical records and documentation.
• Communicate with insurance companies to obtain preauthorization approvals.
• Maintain accurate records of preauthorizations, approvals, and denials.
• Educate healthcare providers on preauthorization requirements and resolve issues.
• Stay updated on insurance regulations and guidelines.

Skills

Prior authorization

Insurance verification

Utilization review

Medical billing

Orthopedics knowledge

Spine/pain management

Payer portals

EMR proficiency

HIPAA compliance

Communication skills

Education

High school diploma or GED

Healthcare-related certificate or associate degree preferred

Tools

Athena EMR

Availity Humana Military

CPT/ICD-10 basics

Job description

We are seeking a highly motivated and detail-oriented individual to join our dynamic healthcare team as an

Orthopedic/Spine Preauthorization Specialist. In this position, you will play a crucial role in ensuring exceptional patient care, and efficient reimbursement within our Preauthorization Department. You will be responsible for reviewing and processing preauthorization requests for Orthopedic, Imaging, Surgery, Pain Management, and Spine procedures as well as Durable Medical Equipment, and PT while working closely with our surgery schedulers, healthcare providers, insurance companies, and patients to ensure timely approvals.

Key Responsibilities:

• Review and evaluate preauthorization requests for orthopedic procedures and treatments, ensuring completeness and accuracy of documentation.
• Verify patient insurance coverage and eligibility for requested services.
• Collaborate with clinical staff to gather necessary medical records and supporting documentation.
• Communicate effectively with insurance companies to obtain preauthorization approvals
• Maintain accurate and up-to-date records of preauthorization requests, approvals, and denials status.
• Educate healthcare providers on preauthorization requirements and assist in resolving any preauthorization related issues or concerns.
• Stay updated on insurance industry regulations, policies, and guidelines related to orthopedic preauthorization.

Required Skills & Qualifications:

• 1+ years’ experience in prior authorizations, insurance verification, utilization review, or medical billing — experience in orthopedics, spine, or pain management preferred.
• High school diploma or GED required; healthcare-related certificate or associate degree preferred.
• Strong knowledge of orthopedic procedures, treatments, and medical terminology.
• Familiarity with payer portals, EMRs (e.g., Athena, Availity Humana Military, etc), and CPT/ICD-10 basics
• Attention to detail and ability to analyze complex medical documentation.
• Strong communication skills, both written and verbal, with the ability to effectively interact with healthcare professionals, insurance companies, and patients.
• Proficient computer skills, including experience with electronic medical record (EMR) systems
• Ability to work independently and as part of a team, managing multiple priorities and meeting deadlines in a fast-paced environment.
• Commitment to maintaining patient confidentiality and adhering to HIPAA guidelines.
• Professional phone etiquette and ability to work under deadlines.
• Bilingual skills a plus (Spanish/ASL).

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