Prior Auth Coordinator

PainPoint Health; United States; À distance; USD 26 000 - 29 000; Plein temps

Avantages offerts par ce poste

Health, Dental & Vision Insurance

Short & Long-Term Disability

401(k) Retirement Plan

Remote Stipend

Paid Time Off (PTO)

Company Paid Holidays

Bonusly Employee Recognition Platform

Résumé du poste

DxTx Pain & Spine seeks a motivated Prior Authorization Coordinator to verify benefits and secure authorizations for interventional pain procedures. This full-time remote role collaborates with payors, practices, and patients to ensure timely approvals.

You will review clinical docs against payer policies, navigate payer portals, and manage multiple authorizations while meeting deadlines. The ideal candidate has 2+ years of benefits verification or prior authorization experience, knowledge of

Qualifications

• 2+ years of prior authorization or benefits verification experience in interventional pain, spine, neurosurgery, orthopedics, or a closely related specialty.
• Direct experience verifying benefits and obtaining authorizations for advanced procedures (SCS, PNS, MILD, SI joint fusion).
• Working knowledge of Medicare, Medicare Advantage, Medicaid, and commercial payer requirements.
• Experience reviewing clinical documentation against payer policies and identifying gaps before submission.
• Experience using payer portals and utilization management platforms/vendors (Availity, EviCore, Carelon, Cohere).
• Experience working within Pain Management required.
• High School Diploma or GED.

Responsabilités

• Verify insurance eligibility and benefits for interventional and advanced procedures.
• Obtain prior and retro authorizations accurately and within required timelines.
• Work directly with payors, practices, vendors, and patients to secure necessary approvals.
• Review clinical documentation against payer policies and identify missing information before submission.
• Navigate payer portals and utilization management systems.
• Monitor authorization trackers and follow requests through completion.
• Document authorization activity and maintain accurate patient and claim information.
• Identify trends or issues that may delay authorizations or claims processing.

Connaissances

Benefits verification

Prior authorization

Organizational skills

Attention to detail

Microsoft Office

HIPAA knowledge

Formation

High School Diploma or GED

Outils

Availity

EviCore

Carelon

Cohere

eCW

athenaOne

Smartsheet

Description du poste

Prior Authorization Coordinator (Benefits Specialist)

Full-Time | $19-$21/hour | Monday-Friday | 8:00 AM-4:30 PM CST | Remote

About DxTx Pain & Spine

At DxTx Pain & Spine, we’re redefining how pain and spine practices thrive. As a physician-aligned partner organization, we empower independent, award-winning physicians across the country by combining clinical autonomy with strong

The Opportunity

As a Prior Authorization Coordinator, you’ll help ensure patients receive timely access to interventional pain and advanced procedures. You’ll be responsible for verifying benefits, reviewing clinical documentation, navigating payer requirements, and obtaining prior authorizations for complex procedures.

What You’ll Do

Benefits Verification & Authorization

Verify insurance eligibility and benefits for interventional and advanced procedures.

Obtain prior and retro authorizations accurately and within required timelines.

Work directly with payors, practices, vendors, and patients to secure necessary approvals.

Review clinical documentation against payer policies and identify missing information before submission.

Navigate payer portals and utilization management (UM) systems.

Monitor authorization trackers and follow requests through completion.

Document authorization activity and maintain accurate patient and claim information.

Identify trends or issues that may delay authorizations or claims processing.

Advanced Procedure Experience

Verify benefits and obtain authorizations for advanced procedures, including:

• Spinal Cord Stimulator (SCS) trials and permanent implants
• Peripheral Nerve Stimulation (PNS)
• Minimally Invasive Lumbar Decompression (MILD)
• Sacroiliac (SI) joint fusion
• Other advanced interventional pain and spine procedures

Collaboration & Communication

Communicate with practices, insurance companies, vendors, patients, and management.

Provide excellent customer service to internal teams and patients.

Collaborate with clinical and administrative teams to ensure authorization requirements are met.

Serve as a backup to the Contact Center Team during peak scheduling periods.

Perform other related duties as assigned.

Required Qualifications

2+ years of prior authorization or benefits verification experience in interventional pain, spine, neurosurgery, orthopedics, or a closely related specialty.

Direct experience verifying benefits and obtaining authorizations for advanced procedures, such as SCS, PNS, MILD, and SI joint fusion.

Working knowledge of Medicare, Medicare Advantage, Medicaid, and commercial payer requirements, including LCD/NCD coverage criteria.

Experience reviewing clinical documentation against payer policies and identifying gaps before submission.

Experience using payer portals and utilization management platforms/vendors such as Availity, EviCore, Carelon, or Cohere.

Experience working within Pain Management required.

Strong organizational, analytical, and problem-solving skills.

Excellent attention to detail and ability to manage multiple authorizations and deadlines.

Proficient in Microsoft Office Suite.

Knowledge of HIPAA privacy and security requirements.

Basic understanding of medical terminology.

High School Diploma or GED.

Preferred Qualifications

Experience handling denials, peer-to-peer coordination, and appeals.

Experience with eCW, athenaOne, or Smartsheet.

Experience identifying authorization or documentation issues before submission.

Experience working in a fast-paced, multi-practice healthcare environment.

What We Offer

• Health, Dental & Vision Insurance
• Accident and Life/AD&D Insurance
• Short & Long-Term Disability
• Emergency Travel Assistance Program
• ID-theft Protection Services
• LifeMart Employee Discount Program
• Health Savings Account (HSA)
• Health Management Tools
• Paid Time Off (PTO)
• Company Paid Holidays
• Parental Leave
• 401(k) Retirement Plan
• Remote Stipend
• Travel Reimbursement
• Continuing Education Reimbursement
• Bonusly Employee Recognition Platform
• DailyPay