Botox Utilization Review Specialist

HealthOp Solutions • Phoenix, AZ

6d • $20 - $25 • Onsite

About The Position

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 required
• 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

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
• Education Level: High school or GED