Prior Authorization Specialist (Contract)

The role

You will manage the full lifecycle of prior authorization workflows for procedures and prescription medications. This role supports pain management and orthopedic clinics to ensure timely authorization approvals.

What you will do

• Submit and manage prior authorizations for pain management and orthopedic procedures
• Manage prior authorizations and reauthorizations for medications
• Navigate pharmacy benefit portals and step-therapy requirements
• Submit formulary exception and medical necessity documentation
• Navigate multiple payer portals efficiently
• Verify insurance eligibility and benefits prior to submission
• Review provider documentation to confirm medical necessity and procedural alignment
• Follow up on pending or denied authorizations
• Identify documentation gaps before submission
• Maintain clear documentation within EHR and tracking systems

Required qualifications

• 3+ years of prior authorization experience in Pain Management or Orthopedics
• Experience with interventional pain and/or orthopedic surgical authorizations
• Experience with prescription drug prior authorizations (medical and pharmacy benefit)
• Experience working on the clinic/provider side (not hospital/facility billing)
• Ability to independently manage high daily authorization volume
• Hands-on experience with payer portals (e.g., Availity, UHC, Carelon/AIM, eviCore, Cohere, CoverMyMeds, etc.)
• Strong working knowledge of CPT codes and procedural terminology
• Experience reviewing documentation for medical necessity
• Exceptional attention to detail and follow-through

Nice to have

• Experience with Medicaid plans, including AHCCCS
• CPC-A or other coding certification
• Familiarity with NCCI edits, bundling rules, and step therapy protocols
• Experience identifying recurring denial patterns and process gaps

About the company

Flagler Health is building the clinical operating system for modern musculoskeletal care. They partner with MSK provider groups and specialty clinics to help them grow and operate more efficiently.