Prior Authorization Specialist

Prior Authorization Specialist Remote

Pain Management Group is currently seeking a Prior Authorization Specialist to remotely join their team. This position is responsible for managing and coordinating the prior authorization process for pain management procedures, imaging, and medications across several pain management center locations. This role ensures timely and accurate authorization submissions by verifying insurance eligibility and benefits, reviewing payer‑specific requirements and Medicare guidelines, and confirming that clinical documentation supports medical necessity.

• Dental insurance
• Health insurance
• Vision insurance
• Life insurance
• Disability insurance
• 401k
• Pay: $50,000 – $60,000/year, offer dependent on experience

• Full time
• Remote
• Monday to Friday
• Minimal travel required with the job – some regional travel for onboarding and as needed for corporate meetings or events.

• Associates degree, preferred
• 2+ years of prior authorization experience in medical office or other healthcare setting
• Strong understanding of insurance plans including Medicare, Medicaid, and commercial payers
• Experience in pain management and with CGS LCD guidelines is a major plus (i.e. familiarity with payer‑specific rules for MBBs, RFAs, ESIs and other interventional procedures)
• Knowledge of ICD‑10 and CPT codes and guidelines.
• Experience with EMRs:
  Citrix, Tru Bridge, Athena, Cerner

• Submit and manage prior authorization requests for pain management procedures, imaging, and/or medications
• Review payer‑specific authorization requirements, medical policies, and Medicare LCD/NCD guidelines
• Verify patient insurance eligibility, benefits, and authorization requirements
• Ensure clinical documentation supports medical necessity before submission
• Track authorization requests and follow up with payers to ensure timely determinations.
• Respond to payer requests for additional clinical information
• Communication authorization approvals, denials, and limitations to providers, scheduling, and any other relevant team
• Coordinate peer‑to‑peer reviews when necessary
• Assist with appeal submissions for denied authorizations
  
  Accurately document authorization status, reference numbers, validity dates, and outcomes in the EMR and/or tracking systems
• Maintain organized records and meet productivity and turnaround time expectations.
• Stay current on payer policy updates

Pain Management Group (PMG) partners with hospitals to manage socially and medically responsible pain management centers that deliver outstanding clinical care with quantifiable outcomes. Through PMG’s model of clinical accountability and integrated team process, PMG partner hospitals and contracted providers strengthen their communities by offering safe and responsible pain treatment and helps patients dealing with chronic pain regain function for their daily life activities using multiple modalities of care.

PMG offers individuals an opportunity to make a difference within the greatest national healthcare crisis of their lifetime by providing our communities with safe, responsible, and accountable pain management treatment. We are looking for people who are hungry, humble, and smart to grow with us and become leaders of influence. We strive to create a workplace full of talented, hard‑working servant leaders who are given the opportunity to contribute to the growth and development of an organization making a difference in our communities.

We partner with health systems and independent hospitals to provide safe and responsible pain management care in the communities they serve. Our partners are provided with the blueprint and ongoing program management resources to cultivate a robust, outpatient pain management service line through Balanced treatment approach, Hosital-based model, Program sustainability, Quantifiable outcomes and results.