Prior Authorization Specialist (Contract)

FLAGLER HEALTH IS BUILDING THE CLINICAL OPERATING SYSTEM FOR MODERN MUSCULOSKELETAL CARE.

We partner with MSK provider groups and specialty clinics to help them grow, operate more efficiently, and deliver better longitudinal care across patient acquisition, clinical workflows, and ongoing patient engagement. Our platform sits at the intersection of care delivery and clinic operations, helping providers capture more value across the full patient lifecycle.

We’ve recently raised our Series B https://www.businesswire.com/news/home/20260810011327/en/Flagler-Health-Raises-%2450-Million-Series-B-to-Build-the-AI-Operating-System-for-Musculoskeletal-Care and are entering our next phase of growth.

ROLE OVERVIEW

Flagler partners directly with pain management and orthopedic clinics to help optimize operations and improve financial performance. Prior authorizations are a critical component of that success.

We are seeking a Prior Authorization Specialist (Contract) to support high-volume authorizations for both procedures and prescription medications. This role focuses on provider/clinic-side workflows and requires someone who understands payer requirements, documentation standards, and how to proactively prevent downstream denials.

The ideal candidate is detail-oriented, experienced in complex authorizations, and comfortable working independently in a fast-paced environment.

WHAT YOU’LL BE DOING

You will help ensure providers receive timely authorization approvals by managing the full lifecycle of prior authorization workflows.

PROCEDURAL AUTHORIZATIONS

• Submit and manage prior authorizations for pain management and orthopedic procedures, including:
• Epidural steroid injections
• Facet injections
• Radiofrequency ablation (RFA)
• SI joint injections
• Advanced imaging (MRI, CT)
• Orthopedic surgical procedures

PRESCRIPTION DRUG AUTHORIZATIONS

• Manage prior authorizations and reauthorizations for medications commonly used in pain management

• Navigate pharmacy benefit portals and step-therapy requirements

• Submit formulary exception and medical necessity documentation when required

AUTHORIZATION MANAGEMENT

• Navigate multiple payer portals efficiently

• Verify insurance eligibility and benefits prior to submission

• Review provider documentation to confirm medical necessity and procedural alignment

• Follow up on pending or denied authorizations

• Identify documentation gaps before submission to reduce preventable denials

• Maintain clear documentation within EHR and tracking systems

• Support billing and reconciliation activities as needed, including resolving authorization-related billing issues

This role requires strong workflow discipline, attention to detail, and the ability to manage a high volume of requests accurately.

REQUIRED QUALIFICATIONS

• 3+ years of prior authorization experience in Pain Management or Orthopedics

• Demonstrated experience with:
• Interventional pain and/or orthopedic surgical authorizations
• Prescription drug prior authorizations (medical and pharmacy benefit)

• Experience working on the clinic/provider side (not hospital/facility billing)

• Ability to independently manage high daily authorization volume

• Hands-on experience with payer portals (e.g., Availity, UHC, Carelon/AIM, eviCore, Cohere, CoverMyMeds, etc.)

• Strong working knowledge of CPT codes and procedural terminology

• Experience reviewing documentation for medical necessity

• Exceptional attention to detail and follow-through

STRONGLY PREFERRED

• Experience with Medicaid plans, including AHCCCS

• CPC-A or other coding certification

• Familiarity with NCCI edits, bundling rules, and step therapy protocols

• Experience identifying recurring denial patterns and process gaps

WHAT SUCCESS LOOKS LIKE

• Strong first-pass approval rates

• Minimal preventable authorization-related denials

• Consistent, timely submissions

• Clear documentation and communica