Experienced Prior Authorization Specialist
hace 6 días
Wichita
Job DescriptionBenefits: • Competitive salary, • Dental insurance, • Health insurance, • Paid time off Experienced Prior Authorization Specialist – Interventional Pain ManagementKansas Pain Consultants Job Type: Full-time, On-Site Schedule: Monday–Friday; no nights, weekends, holidays, or call Compensation: Competitive and based on experience Help Patients Receive the Care They Need Kansas Pain Consultants is seeking an EXPERIENCED Prior Authorization Specialist with a strong background in interventional pain management, spine care, or a related medical specialty. This is not an entry-level position and is On-Site. We are looking for a knowledgeable, persistent, and highly organized professional who understands how to move complex authorization requests from submission to approval. The ideal candidate can interpret clinical documentation, navigate payer requirements, anticipate authorization barriers, and communicate effectively with patients, providers, insurance representatives, and clinical staff. At Kansas Pain Consultants, our mission is to relieve pain, restore function, and improve lives. Your work will be essential to ensuring patients receive timely access to medically necessary procedures, treatments, medications, and diagnostic services. Key Responsibilities • Obtain prior authorizations and pre-certifications for interventional pain procedures, diagnostic testing, medications, and other ordered services., • Manage authorizations for procedures such as epidural steroid injections, medial branch blocks, radiofrequency ablation, sacroiliac joint injections, joint injections, nerve blocks, spinal cord stimulator trials and implants, and other pain-management treatments., • Verify patient eligibility, benefits, coverage limitations, deductibles, co-insurance, referral requirements, and authorization requirements., • Review provider orders and clinical documentation to confirm that payer-specific medical-necessity criteria are addressed before submission., • Identify missing information and work with providers and clinical staff to obtain appropriate documentation., • Submit accurate authorization requests through payer portals, by telephone, or through other required channels., • Monitor pending requests and follow up proactively until a final determination is received., • Track authorization numbers, approved service codes, dates of service, units, expiration dates, treatment limitations, and site-of-service requirements., • Confirm that approved CPT and diagnosis codes match the services scheduled., • Prevent avoidable denials by identifying coverage issues before procedures or treatments are scheduled., • Review denials and determine the appropriate next step, including reconsideration, peer-to-peer review, corrected submission, or formal appeal., • Prepare appeal packets using supporting clinical records, imaging reports, treatment histories, and letters of medical necessity., • Coordinate peer-to-peer reviews between providers and insurance medical reviewers., • Maintain accurate authorization notes and upload supporting documents into the electronic health record and practice-management system., • Communicate authorization status, delays, denials, and coverage concerns clearly to patients and the appropriate internal team members., • Work closely with scheduling, clinical, billing, and provider teams to support efficient patient care and clean claims., • Protect patient confidentiality and comply with HIPAA, payer policies, and organizational procedures., • Stay current on changing payer policies, medical-necessity guidelines, coding requirements, and authorization processes., • Assist with authorization-related workflow improvements and denial-prevention initiatives.Required Qualifications, • At least two years of prior authorization experience in a medical practice, surgery center, hospital, or specialty clinic., • Direct experience obtaining authorizations for medical procedures, advanced imaging, specialty medications, or surgical services., • Strong understanding of commercial insurance, Medicare, Medicaid, Medicare Advantage, and managed-care authorization processes., • Experience using payer portals and communicating with insurance representatives., • Working knowledge of CPT, ICD-10, HCPCS, and medical-necessity requirements., • Ability to read and interpret clinical notes, imaging reports, treatment histories, and provider orders., • Demonstrated experience following complex authorizations through approval, denial, reconsideration, or appeal., • Excellent attention to detail, follow-through, organization, and time-management skills., • Strong written and verbal communication skills., • Ability to manage a high-volume workload while meeting deadlines and maintaining accuracy., • Experience working with electronic health records and practice-management systems., • Commitment to patient service, confidentiality, professionalism, and teamwork.Preferred Qualifications, • Prior authorization experience in interventional pain management., • Experience with spine procedures and implantable pain therapies., • Familiarity with payer requirements for:, • Epidural steroid injections, • Facet joint procedures and medial branch blocks, • Radiofrequency ablation, • Sacroiliac joint injections, • Peripheral nerve blocks, • Spinal cord stimulator trials and implants, • Intrathecal pain pump services, • Advanced imaging, • Specialty and controlled medications, • Experience preparing medical-necessity appeals and coordinating peer-to-peer reviews., • Familiarity with Medicare local coverage requirements and commercial payer clinical policies. What Success Looks Like A successful Prior Authorization Specialist at Kansas Pain Consultants: • Submits complete, accurate requests the first time., • Anticipates payer requirements instead of waiting for preventable denials., • Follows pending cases consistently and communicates delays early., • Understands the clinical purpose behind the services being authorized., • Maintains precise records of approval details, deadlines, and payer communications., • Advocates professionally and persistently for medically necessary patient care., • Helps reduce authorization-related cancellations, delays, and claim denials., • Treats patients with empathy, especially when insurance barriers create stress or uncertainty., • Works collaboratively and remains calm in a fast-paced specialty environment.Why Join Kansas Pain Consultants? Every authorization represents a patient waiting for relief. In this role, your expertise will directly affect patients’ ability to receive timely treatment. Kansas Pain Consultants offers: • Competitive compensation based on experience, • Generous performance-based bonus opportunity, • Comprehensive health insurance, • Dental and vision coverage options, • Life insurance, • Paid time off, • Retirement plan with employer-supported options after the applicable eligibility period, • Professional development opportunities, • Flexible weekday scheduling, • No nights, • No weekends, • No holidays, • Supportive and collaborative team environment, • Meaningful work that improves patients’ access to careApply If you have proven prior authorization experience and understand the urgency, accuracy, and persistence required in an interventional pain management practice, we would like to hear from you. Please submit your résumé along with a brief description of: • Your prior authorization experience, • The specialties and procedure types you have supported, • Your experience managing denials, appeals, and peer-to-peer reviews, • The insurance portals and electronic health record systems you have usedKansas Pain Consultants is an equal opportunity employer. Employment decisions are made without regard to legally protected characteristics.
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