Medical Authorization Specialist – Spine Surgery

• Manage and process surgery authorizations, particularly for orthopedic and spine procedures
• Review authorization requirements and verify insurance information
• Submit prior authorization requests through insurance portals
• Track authorization requests from submission through determination
• Ensure documentation and supporting information are complete and accurate
• Follow up on pending authorizations and outstanding requirements
• Maintain records of authorization status, reference numbers, correspondence, and next steps
• Assist with claims-related and insurance verification tasks
• Review denied or rejected authorization requests and identify denial reasons
• Prepare and submit insurance appeals
• Gather clinical documentation, notes, reports, and supporting records for appeals
• Track appeals and follow up within appropriate timelines
• Communicate updates and outstanding requirements to internal team members
• Navigate multiple insurance portals and research payer-specific requirements
• Make outbound calls to insurance companies regarding authorizations, appeals, claims, and documentation
• Document calls, reference numbers, decisions, and follow-up requirements
• Review procedure and insurance codes
• Reference clinical notes and reports through EHR/EMR systems
• Prepare reports, spreadsheets, and authorization documentation
• Maintain tracking spreadsheets and administrative records
• Handle information in accordance with HIPAA and confidentiality requirements
• Preferred: experience with orthopedic or spine surgery authorizations; familiarity with spine surgery procedure and insurance codes; understanding of workers' compensation; Epic, Cerner, Athena, Google Workspace/Google Sheets, Microsoft Teams, and previous support of a U.S.-based surgical, orthopedic, spine, or specialty medical practice

Requirements

• 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 accuracy when handling medical and insurance information
• Must speak and write English clearly and professionally
• Must have relevant work experience
• Must provide an NBI Clearance and/or Local Police Clearance before onboarding
• Must be available to attend video meetings with camera on when required
• Reliable laptop or desktop computer
• Stable high‑speed internet connection of at least 25 Mbps
• Noise‑canceling headset
• Working webcam
• Quiet and professional work environment
• Preferred: experience with orthopedic or spine surgery authorizations; familiarity with spine surgery procedure and insurance codes; understanding of workers' compensation; Epic, Cerner, Athena, Google Workspace/Google Sheets, Microsoft Teams, and previous support of a U.S.-based surgical, orthopedic, spine, or specialty medical practice

Core Competencies

Demonstrates expertise in managing surgery authorizations, particularly for orthopedic and spine procedures, with a strong understanding of the prior authorization and insurance appeals process. Proficient in navigating insurance portals, handling denials, and ensuring compliance with HIPAA regulations.

Highest-signal resume keywords

• Surgery Authorization Experience
• Insurance Portal Navigation
• Prior Authorization Process
• Insurance Appeals Process
• EHR/EMR Systems Familiarity

Hard Skills

• Authorization Request Submission
• Insurance Verification
• Documentation Review
• Claims Processing
• Procedure Code Familiarity
• Clinical Documentation Review
• Tracking and Reporting
• Denial Reason Identification
• Appeal Preparation
• HIPAA Compliance

Soft Skills

• Attention to Detail
• Professional Communication
• Organizational Skills
• Follow‑Up Skills
• Independent Work

Certifications & Qualifications

• NBI Clearance
• Local Police Clearance

Industry Keywords

• Orthopedic Surgery
• Spine Surgery
• Workers’ Compensation
• Insurance Codes
• Medical Procedure Codes

Tools & Technologies

• Epic
• Cerner
• Athena
• Google Workspace
• Microsoft Teams