Job Title: Full-Time Prior Authorization Representative

Company: The Spine Institute

Job Summary:

The Spine Institute is seeking a skilled Full-Time Prior Authorization Representative to join our healthcare team! This position is crucial in ensuring that patients receive the necessary medical services and procedures by facilitating the authorization process with insurance companies. The ideal candidate will be knowledgeable about insurances, payer websites, medical terminology, and the prior authorization process (experience with radiology and spine procedure authorizations is a plus).

Key Responsibilities:
- Review and process prior authorization requests for radiology orders and in-office spine injections in a timely manner.
- Communicate effectively with healthcare providers, insurance companies, and patients to gather necessary information and clarify authorization requirements.
- Assess clinical documentation and medical necessity to determine compliance with insurance guidelines.
- Maintain detailed records of authorization requests and their outcomes, documenting all communication and follow-ups in the electronic health record (EHR) system (experience working with Advanced MD is a plus).
- Monitor pending authorization requests, ensuring timely responses from insurance companies, and escalate issues as needed.

__Qualifications:

- Experience in a prior authorization role is required.
- Strong understanding of insurance processes, medical terminology, and payer websites (Availity, Carelon, Evicore, etc).
- Excellent communication skills, both written and verbal.
- Strong organizational skills and attention to detail, with the ability to manage multiple tasks and deadlines effectively.
- Ability to work independently.

Benefits:
- Competitive salary
- Health, dental, and vision insurance
- 401(k) with company match
- Paid time off (PTO) and holidays

How to Apply:
Please submit your resume with details about your relevant experience.

The Spine Institute is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.