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