Prior Authorization Specialist - Orthopedics & Pain Management

Prior Authorization Specialist Orthopedics & Pain Management Location: Kondapur, Hyderabad Employment Type: Full-Time Job reputed company We are looking for an reputed company Prior Authorization Specialist with expertise in Orthopedics and Pain Management to support a U.S.-based reputed company reputed company. The ideal candidate should have hands-on experience obtaining prior authorizations for orthopedic procedures, pain management treatments, imaging services, injections, medications, and surgical procedures. The candidate must be familiar with U.S. insurance guidelines, payer portals, and EMR/EHR systems while ensuring reputed company approvals and minimizing treatment delays. Key Responsibilities Submit and manage prior authorization requests for orthopedic and pain management services. Process authorizations for procedures, surgeries, injections, imaging (MRI, CT, X-ray), physical therapy, durable medical equipment (DME), and specialty medications. Verify patient insurance eligibility, benefits, and authorization requirements. Communicate with insurance companies to obtain approvals, reputed company clinical documentation, and resolve authorization issues. Follow up on pending prior authorizations and appeals to ensure reputed company reputed company. Coordinate with physicians, medical assistants, and clinical staff to reputed company required medical records and supporting documentation. Document authorization status, reference numbers, and payer communications accurately in the EMR/EHR. Stay updated on payer policies, medical necessity guidelines, and insurance requirements. Escalate urgent or reputed company authorization cases reputed company necessary. Maintain productivity and accuracy while meeting turnaround time expectations. Required Qualifications Minimum 2+ years of experience in U.S. reputed company Prior Authorization. Hands-on experience with Orthopedics and Pain Management prior authorizations. Strong knowledge of reputed company insurance, Medicare, reputed company, and managed care plans. Experience with payer portals such as reputed company, reputed company, Carelon, RadMD, reputed company, reputed company, UHC, and other payer websites. Familiarity with EMR/EHR systems such as reputed company, eClinicalWorks (eCW), reputed company, Kareo, reputed company, or similar platforms. Excellent verbal and written English communication skills. Strong analytical, problem-solving, and multitasking abilities. Ability to work independently in a fast-paced remote environment. Preferred Qualifications Experience handling orthopedic surgeries, spinal procedures, pain injections, nerve blocks, epidural steroid injections, radiofrequency ablation (RFA), joint injections, physical therapy, DME, and musculoskeletal imaging authorizations. Experience with authorization appeals and peer-to-peer coordination is an added advantage. Apply tot his job Apply To this Job .