Medical Authorization Specialist (Spine Surgery)

The ideal candidate understands the urgency and accuracy required when coordinating surgical authorizations and is comfortable communicating directly with insurance companies, navigating multiple payer portals, reviewing clinical documentation, and working with procedure and insurance codes.

Scope of Work / Responsibilities

• Manage and process surgery authorizations, particularly for orthopedic and spine procedures
• Review authorization requirements and verify necessary insurance information
• Submit prior authorization requests through appropriate insurance portals
• Track authorization requests from initial submission through determination
• Ensure required documentation and supporting information are complete and accurate
• Follow up on pending authorizations and outstanding requirements
• Maintain accurate records of authorization status, reference numbers, correspondence, and next steps
• Assist with claims-related and insurance verification tasks as required

Insurance Appeals & Denial Management

• Review denied or rejected surgery authorization requests
• Identify denial reasons and determine the appropriate next steps
• Assist with preparing and submitting insurance appeals
• Gather clinical documentation, notes, reports, and other supporting records required for appeals
• Track appeals and follow up within appropriate timelines
• Maintain clear documentation of appeal status and insurance correspondence
• Communicate updates and outstanding requirements to the appropriate internal team members

Insurance Portal Navigation & Communication

• Navigate multiple insurance portals to submit, review, and track authorization requests
• Obtain or coordinate appropriate portal access when necessary
• Research payer-specific authorization requirements
• Make outbound calls to insurance companies regarding authorizations, appeals, claim status, and documentation requirements
• Communicate professionally with insurance representatives
• Document calls, reference numbers, decisions, and follow-up requirements accurately

Medical Coding & Documentation Support

• Review relevant procedure and insurance codes associated with authorization requests
• Work with spine surgery and orthopedic procedure codes when applicable
• Reference clinical notes, reports, and supporting documentation through EHR/EMR systems such as Epic, Cerner, or Athena
• Prepare and organize reports, spreadsheets, and authorization-related documentation
• Maintain accurate tracking spreadsheets and administrative records
• Ensure all information is handled accurately and in accordance with HIPAA and confidentiality requirements

Top 3 Priorities

1. Surgery Authorization Management

Accurately manage and process surgery authorizations, with particular emphasis on orthopedic and spine procedures.

2. Insurance Portal Navigation

Confidently navigate different payer portals, obtain appropriate access, submit authorization requests, and track cases through completion.

3. Insurance Communication & Appeals

Communicate directly with insurance companies and effectively manage authorization follow-ups, denials, and appeals.

Requirements

Required Skills & Experience

• Previous hands-on surgery authorization experience is required
• Previous experience navigating multiple insurance portals is required
• Strong understanding of the prior authorization and insurance appeals process is required
• Experience communicating directly with insurance companies is required
• Experience submitting and tracking authorization requests from start to completion
• Experience handling authorization denials and supporting the appeals process
• Ability to determine documentation and information required by different insurance companies
• Familiarity with insurance and medical procedure codes
• Ability to review clinical notes, reports, and supporting medical documentation
• Familiarity with EHR/EMR systems such as Epic, Cerner, Athena, or similar platforms
• Strong attention to detail and accuracy
• Ability to organize and track multiple authorization cases simultaneously
• Ability to prioritize tasks based on urgency and authorization timelines
• Strong documentation and follow-up skills
• Professional communication skills when speaking with insurance representatives
• Ability to work independently and consistently follow cases through resolution
• Understanding of HIPAA, confidentiality, and the importance of accuracy when handling medical and insurance information

Preferred Experience

• Experience with orthopedic or spine surgery authorizations
• Familiarity with spine surgery procedure and insurance codes
• Understanding of workers’ compensation
• Experience working with Epic
• Experience working with Cerner
• Experience working with Athena
• Experience using Google Workspace, particularly Google Sheets for authorization tracking
• Experience using Microsoft Teams
• Previous experience supporting a U.S.-based surgical, orthopedic, spine, or specialty medical practice

Tools & Software

• Epic – Reviewing and referencing clinical notes and reports
• Cerner – Reviewing and referencing clinical notes and reports
• Athena – EHR/EMR familiarity is beneficial
• Insurance Portals – Authorization submission, status tracking, and appeals
• Google Workspace – Documentation, spreadsheets, and tracking
• Microsoft Teams – Internal communication
• Internet-Based Phone System – Outbound communication with insurance companies

Basic Requirements

• Must speak and write English clearly and professionally.
• Must have relevant work experience.
• Must be able to provide an NBI Clearance and/or Local Police Clearance before onboarding (mandatory).
• Must be available to attend video meetings with camera on when required.

Technical Requirements

• Computer: Reliable laptop or desktop computer.
• Internet: Stable high-speed internet connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Working webcam for virtual meetings.
• Workspace: Quiet and professional work environment.

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification.
• Top 1% VA Performance Training: Access to proprietary training on communication, client management, productivity systems, and best practices.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on performance.