What is your mission?

• Lead and execute prior authorization requests and secure approvals for pain management procedures
• Verify patient insurance coverage and perform coordination of benefits (COB) to route submissions to the correct payor
• Review and interpret medical policies, ensuring submissions meet medical necessity criteria with accurate CPT codes, levels, and laterality
• Maintain accurate documentation, including NAR (No Authorization Required) notifications, benefits, and eligibility details in patient records
• Compile and submit complete clinical documentation such as physical therapy records and imaging reports
• Confirm insurance benefits and determine patient financial responsibility including copays and coinsurance
• Update and monitor CRM systems with authorization status and procedure details
• Schedule approved procedures and ensure workflow continuity
• Communicate with healthcare providers to resolve discrepancies and respond promptly to inquiries
• Review patient medical records to identify critical factors such as blood thinner usage during the authorization process
• Analyze denial letters and submit appeals to overturn unfavourable insurance decisions
• Coordinate with internal departments on issues affecting authorizations or billing claims
• Ensure strict compliance with U.S. HIPAA regulations for PHI security and confidentiality

Who are we looking for?

• Bachelor’s degree in a related field or equivalent healthcare experience
• 1+ years of experience in prior authorization within a healthcare environment
• 2+ years experience in call center operations, healthcare administration, patient services, or insurance verification roles
• Proven experience working in medical facilities or healthcare BPO operations with exposure to high-volume workflows
• Strong working knowledge of U.S. insurance plans including Medicare, Medicaid, HMOs, PPOs, Workers’ Compensation, and MVAs
• Proficient in medical terminology, anatomy & physiology, and coding systems such as ICD-10 and CPT/HCPCS
• Experience reviewing payor policies, authorization submissions, and clinical documentation requirements
• Ability to manage high daily transaction volumes including calls, verifications, and approvals
• Excellent communication skills for coordination with patients, providers, and internal teams
• Strong attention to detail and ability to ensure high-quality, error-free submissions
• Ability to work independently with minimal supervision in a fast-paced environment
• Demonstrates high productivity, reliability, and consistent attendance