Prior Authorization Representative

PRIOR AUTHORIZATION REPRESENTATIVE

Texas Institute for Neurological Disorders / US Neurology Associates
Department: Revenue Cycle / Operations
Schedule: Full-Time, Monday-Friday
Location: On-Site, Plano / Frisco

The Prior Authorization Representative is responsible for completing high-volume, end-to-end prior authorization work for a multi-site outpatient neurology practice. This role supports office visits, diagnostic testing, procedures, infusion therapies, injections, and ancillary services by ensuring payer requirements are met before scheduled care.

The ideal candidate brings direct, dedicated prior authorization experience in neurology, infusion, or another complex specialty care setting. This is not an entry-level or adjacent front-desk, billing, or insurance verification role; the successful candidate must be able to independently manage authorization queues, payer portals, clinical documentation requirements, denials, and time-sensitive follow-up.

KEY RESPONSIBILITIES

Authorization Processing

• Initiate, submit, track, and close prior authorization requests for office visits, MRI, EMG, EEG, sleep studies, infusions, Botox and other injections, and additional diagnostic and ancillary services.
• Review scheduled services and payer requirements to determine authorization, referral, and medical necessity documentation needs.
• Obtain and organize clinical records, diagnosis codes, procedure codes, treatment plans, and supporting documentation required for submission.
• Complete authorization activity through payer portals, phone, fax, and electronic workflows within established turnaround times.
• Monitor pending cases daily and proactively follow up with payers, providers, and clinical teams until a final determination is received.
• Renew authorizations for ongoing treatment plans before expiration.

Denials, Appeals & Escalations

• Identify authorization denials and incomplete requests, determine the reason, and gather the information needed for reconsideration or appeal.
• Coordinate with providers and clinical staff on letters of medical necessity, peer-to-peer reviews, and additional clinical documentation.
• Escalate urgent, high-value, and at-risk cases to the Prior Authorization Manager according to established protocols.
• Document payer decisions, reference numbers, effective dates, approved units, and limitations accurately in eClinical
  
  Works.

Scheduling & Patient Access Support

• Confirm authorization clearance before services are rendered and communicate status to scheduling and clinic teams.
• Flag at-risk cases in advance of appointments to prevent avoidable cancellations, rescheduling, and patient dissatisfaction.
• Verify relevant benefit and coverage information and route financial counseling needs to the appropriate team.
• Respond promptly and professionally to authorization questions from patients, clinic staff, providers, and payer representatives.

Productivity, Quality & Compliance

• Maintain accurate, real-time work queues and tracking for pending, approved, denied, appealed, and expired authorizations.
• Meet established productivity, quality, aging, and turnaround-time standards.
• Identify recurring payer or workflow issues and share trends with the Prior Authorization Manager.
• Follow HIPAA, payer, and organizational policies at all times.

QUALIFICATIONS

Required

• Minimum 2 years of dedicated prior authorization experience in an outpatient specialty healthcare setting.
• Demonstrated experience independently managing high-volume authorization queues.
• Direct experience with payer portals, medical necessity requirements, clinical documentation, denials, and appeals.
• Working knowledge of commercial, Medicare, Medicare Advantage, and Medicaid managed care plans.
• Experience with eClinical
  
  Works or a comparable EMR/practice management system.
• Ability to prioritize time-sensitive cases, manage competing deadlines, and maintain strong attention to detail.
• Clear written and verbal communication skills and comfort working with clinical teams and payer representatives.

Preferred

• Prior authorization experience in neurology or infusion services.
• Experience with EMG, EEG, MRI, Botox, infusion therapies, sleep studies, and related specialty procedures.
• Experience with Well Med, United Healthcare, Blue Cross Blue Shield of Texas, and Texas Medicaid managed care plans.
• Experience in a multi-site outpatient specialty practice.
• CPAR or comparable patient access certification.

COMPENSATION & BENEFITS

Salary Range: Commensurate with experience
Benefits: Medical, dental, vision, PTO, and…