Preauthorization Specialist

Job Title: Preauthorization Specialist for JRMC Pain Clinic

Reports to: Chief Financial Officer

Department: Outpatient Pain Clinic

Job Summary: The Preauthorization Specialist is a full-time, non-exempt position. This ideal candidate will be responsible for coordinating and securing prior authorizations for all outpatient pain management procedures and outpatient infusion services, ensuring accurate scheduling, optimizing patient flow, and supporting revenue-cycle compliance. This role works closely with providers, nursing staff, billing/coding, case management, and insurance companies to verify benefits, obtain required approvals, and communicate updates to patients and clinical teams.

This position plays a critical role in preventing treatment delays, reducing denials, and ensuring proper patient preparation and documentation for each date of service.

Demonstrates Competency in the following areas:

Reviews provider orders and clinical documentation for competencies prior to submission.

Obtains preauthorization for all pain procedures, injections, blocks, ablations, and other interventions.

Will work closely with the Pharmacy Director to ensure availability and secure preauthorization for infusion therapies, including but not limited to biologics, antibiotics, hydration, chemotherapy supportive medications, iron, and specialty infusions.

Verifies patient insurance benefits, coverage limitations, and out-of-pocket requirements.

Communicate with payors to resolve discrepancies, request extensions, and appeal initial denials.

Tracks authorization status and maintains documentation consistent with hospital, CMS, and payor guidelines.

Ensure authorizations are linked correctly to scheduled visits in the EMR/practice management system.

Notifies providers promptly of missing documentation or payor-required criteria.

Coordinates and schedules all outpatient pain procedures and infusion appointments.

Ensures proper spacing, room availability, and staffing alignment for safe patient flow.

Confirms transport needs, special equipment, delivery schedules, and pharmacy preparation times.

Provides appointment reminders and communicates prep instructions to patients.

Schedules follow-up appointments as required by clinical protocols and payor standards.

Serves as the primary point of contact for patients regarding insurance status, authorization requirements, and appointment details.

Provides clear, compassionate education about prep instructions, arrival times, and expectations.

Assists with financial counseling referrals when patients require cost estimates or