Prior Authorization Team Lead

Prior Authorization Team Lead
Full-Time | Remote | $23/hr
Schedule: Monday-Friday 8:00 AM-4:30 PM

About DxTx
DxTx Pain & Spine is a physician-aligned partner organization dedicated to supporting independent pain and spine practices through operational excellence while preserving clinical autonomy. We partner with award-winning physicians nationwide, providing support in compliance, finance, ASC operations, marketing, and other key business functions.

The Opportunity
As a Prior Authorization Team Lead, you will oversee and support all aspects of the prior authorization process for interventional pain management procedures, including advanced procedures performed in office and outpatient settings. You'll serve as a department resource and subject matter expert while supporting team training, workflow improvements, and authorization accuracy.

What You'll Do
Prior Authorization & Patient Access

• Collect and review documentation required for prior and retro authorization requests.

• Review payer medical necessity guidelines and authorization requirements.

• Communicate with practices to obtain additional information needed for procedures and medication requests.

• Navigate payer portals and monitor provider and clinic communications to ensure timely responses.

• Document account activity and maintain accurate patient and claim information.

Team Support & Operations

• Monitor procedure trackers and assist leadership in identifying workflow gaps.

• Serve as a subject matter expert on medical policies, departmental procedures, and affiliate workflows.

• Lead team huddles, distribute meeting notes, and assist with team training, mentoring, audits, and cross-coverage.

• Support new practice and procedure integrations, including workflow and SOP development.

Process Improvement & Collaboration

• Identify authorization trends or issues that may delay claims processing and recommend solutions.

• Collaborate with practices, vendors, insurance carriers, patients, management, and internal teams.

• Provide outstanding customer service and support throughout the department.

• Perform other related duties as assigned.

You'll Thrive in This Role If You...

• Are highly organized and detail-oriented.

• Enjoy solving complex authorization and insurance-related challenges.

• Communicate effectively with providers, staff, and insurance carriers.

• Enjoy mentoring teammates and improving processes.

• Thrive in a collaborative remote environment.

Qualifications

• High School Diploma or GED required.

• At least one (1) year of prior authorization experience in a clinical setting required.

• Excellent verbal and written communication skills.

• Strong organizational, analytical, and problem-solving abilities.

• Proficiency with Microsoft Office Suite or similar software.

• Extensive knowledge of medical policies and LCDs related to pain management procedures.

• Basic understanding of medical terminology.

• Experience navigating payer portals to obtain authorizations and review medical policies.

Benefits We Offer

• Health, Dental & Vision Insurance

• Accident and Life/AD&D Insurance

• Short & Long-Term Disability

• Emergency Travel Assistance Program

• ID-Theft Protection Services

• Health Savings Account (HSA)

• Health Management Tools

• Paid Time Off (PTO)

• Company Paid Holidays

• Paternal Leave

• 401(k)

• Remote Stipend

• Travel Reimbursement

• Continuing Education Reimbursement

• Bonusly Employee Recognition Platform

• DailyPay On-Demand Pay Access

• LifeMart Employee Discount Program

Ready to Join Our Team?
If you're an experienced prior authorization professional looking to make an impact in a collaborative, remote environment, we encourage you to apply today and help support timely patient access to care.
An Equal Opportunity Employer

We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

Originally posted on Himalayas