Prior Auth Coordinator

Painpoint-Health; United States; Remote; USD 40,000 - 44,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

PTO

401(k)

Job summary

DxTx Pain & Spine is seeking a dedicated Prior Authorization Coordinator to verify benefits and obtain authorizations for advanced interventional procedures. You will interact with payors, practices, vendors, and patients to ensure timely approvals and accurate documentation.

Responsibilities include reviewing clinical information, navigating payer portals, and maintaining robust authorization trackers. This role supports a remote, full-time schedule with standard business hours and a focus on

Qualifications

• 2+ years in prior authorization or benefits verification.
• 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 such as Availity, EviCore, Carelon, or Cohere.
• Experience working within Pain Management required.
• Strong organizational, analytical, and problem-solving skills.
• Proficient in Microsoft Office Suite.
• Knowledge of HIPAA privacy and security requirements.
• High School Diploma or GED.

Responsibilities

• 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.

Skills

Prior Authorization

Benefits Verification

Interventional Pain

Documentation Review

Payer Portals

UM Systems

Microsoft Office

HIPAA Compliance

Organizational Skills

Education

High School Diploma or GED

Tools

Availity

EviCore

Carelon

Cohere

eCW

athenaOne

Smartsheet

Job description

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

An Equal Opportunity Employer

We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.