Prior Authorization Specialist

Virginia iSpine Physicians PC, a well-established Interventional Spine/MSK practice in Central Virginia, is seeking a Prior Authorization Specialist to join our team to help our patients reconnect with what is meaningful to them. We recently relocated to a brand new 7,500 square feet facility with an onsite physical therapy area and a fully-equipped procedure suite, complete with onsite anesthesia services. Our practice is actively involved in innovative spine research. The staff at Virginia iSpine Physicians specialize in caring for patients with painful spine and musculoskeletal disorders and exercise a team-based approach to improve patient’s level of function and quality of life.

The Prior Authorization Specialist is responsible for ensuring that all insurance verifications and authorizations are obtained for appointments and procedures within our Interventional Spine practice. This role involves close collaboration with insurance companies, physicians, patients, and other healthcare professionals to ensure timely and accurate processing of prior authorization requests.

Job Responsibilities:

• Verify patient insurance coverage and benefits for services, calculate deductible and copayments for patients upcoming visits.
• Review medical records, treatment plans, and insurance policies to determine the need for prior authorization for orthopedic procedures.
• Submit prior authorization requests to insurance companies and follow up on approvals or denials for procedures including Epidural Steroid Injections, Radiofrequency Ablations, Kyphoplasty, Vertebroplasty, Spinal Cord Stimulation trials, Discography, etc.
• Ensure all required documentation is complete and submitted to insurance providers promptly.
• Act as a liaison between patients, healthcare providers, and insurance companies to facilitate the prior authorization process.
• Meet weekly with providers and management to discuss authorization status, denials, and appeals in process.
• Maintain accurate and detailed records of all prior authorization requests, approvals, denials, and communications.
• Assisting with answering phones and other front desk duties as needed and work on assigned projects with manager.

Requirements:

• Strong understanding of procedures and terminology.
• Knowledge of insurance policies, medical coding (CPT, ICD-10), and the prior authorization process.
• Experience with Availity, Cohere, Evicore, etc.
• Excellent communication and interpersonal skills.
• Detail-oriented with strong organizational skills.
• Proficient in medical billing software and electronic health records (EHR) systems.

Education and Experience:

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration or a related field preferred.
• Minimum of 2 years of experience in medical prior authorization, medical billing, or a related field, preferably within an ortho setting.
• Experience with insurance verification and prior authorization process
• Engage with staff and patients in a professional manner

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off

Experience:

• Insurance verification: 2 years (Preferred)

Ability to Relocate:

• Henrico, VA 23238: Relocate before starting work (Required)

Work Location: In person

Salary : $18 - $22