Botox Prior Authorization

Summary: 

A Botox Prior Authorization Specialist secures insurance approval for therapeutic Botox injections (e.g., migraines, spasms, hyperhidrosis) by verifying benefits, reviewing medical records for clinical necessity, and submitting documentation to payers. This role involves managing, tracking, and appealing denials to ensure timely treatment access, requiring strong communication skills and knowledge of medical terminology.  

Job Description: 

Authorization Responsibilities 

• Documentation & Submission: Review medical records for diagnosis codes (e.g., ICD-10 for chronic migraine, dystonia) and submit authorization requests to insurance companies. 
• Medical Necessity Verification: Ensure requests meet specific clinical criteria (e.g., failure of previous, less intensive treatments). 
• Insurance Coordination: Act as a liaison between providers and payers, verifying benefits, eligibility, and coverage limitations. 
• Tracking & Follow-up: Monitor the status of pending, approved, and denied requests, tracking them in electronic health record systems. 
• Denial Management: Research denied claims, submit appeals, and supply additional documentation for clinical necessity. 
• Communication: Notify patients and clinical staff regarding authorization status and potential out-of-pocket costs.  
• Performs other duties as assigned by supervisor or management to support operational and organizational needs. 

Required Education: 

• High School Diploma or GED 

Required Experience: 

• Minimum 3 years of experience in prior authorizations, referrals, or a related medical office role. 
• Knowledge of insurance processes and medical terminology required. 
• Experience with Athena required. 

Requested Qualifications/Skills: 

• Understanding of ICD-10/CPT coding, medical terminology, and, ideally, familiarity with specialized Botox authorization guidelines 
• Ability to perform efficiently and juggle multiple priorities in a fast-paced, high-volume environment. 
• Strong multitasking and organizational skills. 
• Strong communication, interpersonal, and problem-solving skills. 
• Ability to handle confidential information with discretion and professionalism.  
• Team collaboration skills. 

Benefits 

Foothills Neurology offers a comprehensive benefits package including: 

• Medical, Dental, and Vision Insurance 
• Employer-Paid Life Insurance 
• 401(k) with Employer Match 
• Paid Time Off (PTO) 
• Paid Holidays 
• Voluntary Supplemental Benefits 

Why Join Foothills Neurology? 

At Foothills Neurology, we are committed to providing exceptional patient care while fostering a supportive, collaborative, and professional work environment. Our Facilities Team plays a critical role in ensuring our patients, providers, and staff have a safe and welcoming environment every day.