Botox Utilization Review Specialist - Phoenix, AZ

HealthOp Solutions • Phoenix, AZ

2d • Onsite

About The Position

This position plays a vital role in ensuring patients receive timely access to medically necessary therapeutic Botox treatments. The role offers a consistent weekday schedule and the opportunity to work closely with clinical teams and insurance payers in a fast-paced, supportive healthcare environment. The ideal team member is detail-oriented, highly organized, and experienced in utilization review and prior authorizations. They are comfortable interpreting clinical documentation, navigating payer requirements, and communicating clearly with patients and healthcare staff. They are proactive, collaborative, and committed to supporting quality patient care. The Botox Utilization Review Specialist is responsible for obtaining insurance authorization for therapeutic Botox injections, including treatments for migraines, spasms, dystonia, and hyperhidrosis. This role reviews medical records for clinical necessity, verifies benefits, submits authorization requests, and manages denials and appeals. Strong knowledge of insurance processes, medical terminology, and documentation standards is required to ensure timely treatment approval.

Requirements

• High School Diploma or GED
• Minimum of 3 years of experience in prior authorizations, referrals, or a related medical office role
• Knowledge of insurance processes and medical terminology
• Experience using Athena
• Understanding of ICD-10 and CPT coding
• Strong multitasking and organizational skills
• Ability to perform efficiently in a high-volume, fast-paced environment
• Excellent communication, problem-solving, and team collaboration skills
• Insurance verification experience

Responsibilities

• Review medical records to validate diagnoses and supporting documentation
• Submit prior authorization requests using appropriate ICD-10 and CPT codes
• Verify medical necessity based on payer-specific clinical criteria
• Coordinate with insurance carriers to confirm eligibility, benefits, and coverage limitations
• Track pending, approved, and denied authorizations within the electronic health record
• Research denied requests and submit appeals with required clinical documentation
• Communicate authorization status and potential out-of-pocket costs to patients and clinical staff
• Maintain accurate records while handling confidential information with professionalism

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1-10 employees