01Overview
Job Title: Prior Authorization Specialist Orthopedics & Pain Management
Location: Kondapur , Hyderabad
Employment Type: Full-Time
Job Summary
We are looking for an experienced Prior Authorization Specialist with expertise in Orthopedics and Pain Management to support a U.S.-based healthcare practice. 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 timely 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, provide clinical documentation, and resolve authorization issues.
- Follow up on pending prior authorizations and appeals to ensure timely decisions.
- Coordinate with physicians, medical assistants, and clinical staff to gather 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 complex authorization cases when necessary.
- Maintain productivity and accuracy while meeting turnaround time expectations.
Required Qualifications
- Minimum 2+ years of experience in U.S. Healthcare Prior Authorization.
- Hands-on experience with Orthopedics and Pain Management prior authorizations.
- Robust knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
- Expe .
