Injection Authorization Specialist

Job Title: Injection Authorization Specialist

Location: Remote

Job Type: Full-time

Tentative Start Date: As soon as possible

Position Overview:
The Injection Authorization Specialist is responsible for obtaining and managing prior authorizations for injectable therapies, with a primary focus on viscosupplementation and other procedure-based injections across all insurance carriers. This role ensures timely approvals, minimizes delays in patient care, and maintains compliance with payer requirements.

This position will also support a transitional phase of Botox authorization management, with the expectation of assuming and stabilizing workflows before long-term redistribution, if applicable. Additionally, this role will serve as cross-coverage support for EMG and diagnostic imaging authorizations to ensure continuity of operations across the department.

The ideal candidate is highly organized, detail-oriented, and experienced in navigating complex insurance requirements within a fast-paced specialty practice.

Key Responsibilities:

Injection Authorization Management

Submit and manage prior authorization requests for viscosupplementation and other injections across all insurance carriers as the primary area of responsibility.

Support the transition and temporary management of Botox authorizations, ensuring continuity, accuracy, and timely processing during the handoff period.

Verify insurance benefits, coverage criteria, and medical necessity requirements prior to submission.

Ensure all clinical documentation supports authorization requests, including provider notes, prior treatment history, and conservative care measures.

Track authorization status and proactively follow up with payers to prevent delays or denials.

Communicate approvals, denials, and pending statuses to clinical and scheduling teams in a timely manner.

Coordinate with providers and staff to align scheduling with authorization status and validity periods.

Denials and Appeals

Review denied authorizations and determine root cause.

Prepare and submit appeals with appropriate clinical documentation and justification.

Escalate complex or high-risk denials to leadership as needed.

Cross-Coverage Support

Provide backup support for EMG and diagnostic imaging authorizations (MRI, CT, X-ray, etc.) as needed.

Maintain working knowledge across service lines to ensure seamless operational coverage.

Coordination and Communication

Serve as a liaison between providers, clinical teams, patients, and insurance carriers.

Provide clear communication regarding authorization requirements, status updates, and next steps.

Assist in resolving authorization-related barriers to care.

Documentation and Compliance

Maintain accurate, real-time documentation of all authorization activity within the EMR and/or tracking systems.

Ensure compliance with payer policies, regulatory requirements, and internal protocols.

Monitor authorization expiration dates and ensure services are performed within approved timeframes.

Operational Support

Identify trends in denials, delays, or payer-specific challenges and report findings to leadership.

Assist in refining workflows to improve turnaround times and approval rates.

Support departmental and organizational goals related to efficiency, access, and quality of care.

Other Duties

Perform all other duties as assigned in support of the practice.

Qualifications:

Minimum of 2 years of experience in prior authorizations, preferably in a specialty or procedural practice.

Strong experience with injection authorizations, particularly viscosupplementation, required.

Experience with Botox authorizations preferred.

Familiarity with EMG and diagnostic imaging authorizations preferred.

Strong understanding of insurance plans, payer guidelines, and medical necessity criteria.

Experience working with EMR systems and payer authorization portals.

Excellent organizational skills and attention to detail.

Ability to manage high-volume workflows and shifting priorities.

Strong communication and problem-solving abilities.