Prior Auth Coordinator

• 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.

• 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

• 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.

• 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.

• 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.

• 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.