Prior Authorization Specialist (Contract)
About The Position
Flagler Health is a fast-growing healthtech company transforming how healthcare organizations deliver care through AI-powered workflow automation, remote patient engagement, and chronic care programs. Our platform has already served over 1.5 million patients and is trusted by providers and payers to improve efficiency, lower costs, and drive better outcomes. With a unique freemium model and minimal direct competition, we are poised to capture a large share of the +$5T U.S. healthcare industry. Role Overview Flagler partners directly with pain management and orthopedic clinics to help optimize operations and improve financial performance. Prior authorizations are a critical component of that success. We are seeking a Prior Authorization Specialist (Contract) to support high-volume authorizations for both procedures and prescription medications. This role focuses on provider/clinic-side workflows and requires someone who understands payer requirements, documentation standards, and how to proactively prevent downstream denials. The ideal candidate is detail-oriented, experienced in complex authorizations, and comfortable working independently in a fast-paced environment.
Requirements
- 3+ years of prior authorization experience in Pain Management or Orthopedics
- Demonstrated experience with: Interventional pain and/or orthopedic surgical authorizations
- Prescription drug prior authorizations (medical and pharmacy benefit)
- Experience working on the clinic/provider side (not hospital/facility billing)
- Ability to independently manage high daily authorization volume
- Hands-on experience with payer portals (e.g., Availity, UHC, Carelon/AIM, eviCore, Cohere, CoverMyMeds, etc.)
- Strong working knowledge of CPT codes and procedural terminology
- Experience reviewing documentation for medical necessity
- Exceptional attention to detail and follow-through
Nice To Haves
- Experience with Medicaid plans, including AHCCCS
- CPC-A or other coding certification
- Familiarity with NCCI edits, bundling rules, and step therapy protocols
- Experience identifying recurring denial patterns and process gaps
Responsibilities
- Submit and manage prior authorizations for pain management and orthopedic procedures, including: Epidural steroid injections
- Facet injections
- Radiofrequency ablation (RFA)
- SI joint injections
- Advanced imaging (MRI, CT)
- Orthopedic surgical procedures
- Manage prior authorizations and reauthorizations for medications commonly used in pain management
- Navigate pharmacy benefit portals and step-therapy requirements
- Submit formulary exception and medical necessity documentation when required
- Navigate multiple payer portals efficiently
- Verify insurance eligibility and benefits prior to submission
- Review provider documentation to confirm medical necessity and procedural alignment
- Follow up on pending or denied authorizations
- Identify documentation gaps before submission to reduce preventable denials
- Maintain clear documentation within EHR and tracking systems
- Support billing and reconciliation activities as needed, including resolving authorization-related billing issues
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
