Botox Utilization Review Specialist - Phoenix, AZ at HealthOp Solutions

Phoenix, Arizona, United States -

Full Time

Start Date

Immediate

Expiry Date

03 Jul, 26

Salary

25.0

Posted On

04 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization review, Prior authorizations, Medical terminology, ICD-10 coding, CPT coding, Athena EHR, Insurance verification, Medical records review, Appeals management, Clinical documentation, Multitasking, Organizational skills, Communication, Problem-solving, Team collaboration

Industry

Hospitals and Health Care

Description

Job Title: Botox Utilization Review Specialist Location: Phoenix, AZ Hours & Schedule: Full-time, Monday through Friday, mornings to 4:00 PM Work Environment: Neurology Clinic Salary / Hourly Rate: $20–25 per hour Why work with us: This position plays a vital role in ensuring patients receive timely access to medically necessary therapeutic Botox treatments. The role offers a consistent weekday schedule and the opportunity to work closely with clinical teams and insurance payers in a fast-paced, supportive healthcare environment. What our ideal new team member looks like: The ideal team member is detail-oriented, highly organized, and experienced in utilization review and prior authorizations. They are comfortable interpreting clinical documentation, navigating payer requirements, and communicating clearly with patients and healthcare staff. They are proactive, collaborative, and committed to supporting quality patient care. Job Summary: The Botox Utilization Review Specialist is responsible for obtaining insurance authorization for therapeutic Botox injections, including treatments for migraines, spasms, dystonia, and hyperhidrosis. This role reviews medical records for clinical necessity, verifies benefits, submits authorization requests, and manages denials and appeals. Strong knowledge of insurance processes, medical terminology, and documentation standards is required to ensure timely treatment approval. Job Duties & Responsibilities: Review medical records to validate diagnoses and supporting documentation Submit prior authorization requests using appropriate ICD-10 and CPT codes Verify medical necessity based on payer-specific clinical criteria Coordinate with insurance carriers to confirm eligibility, benefits, and coverage limitations Track pending, approved, and denied authorizations within the electronic health record Research denied requests and submit appeals with required clinical documentation Communicate authorization status and potential out-of-pocket costs to patients and clinical staff Maintain accurate records while handling confidential information with professionalism Prerequisites / License & Certification Requirements: High School Diploma or GED Minimum of 3 years of experience in prior authorizations, referrals, or a related medical office role Knowledge of insurance processes and medical terminology Experience using Athena is required Understanding of ICD-10 and CPT coding Strong multitasking and organizational skills Ability to perform efficiently in a high-volume, fast-paced environment Excellent communication, problem-solving, and team collaboration skills How to Apply If you’re ready to contribute your skills to a respected neurology practice and grow within a supportive environment, please submit your updated resume for confidential consideration. Cover letters and references are encouraged but not required. High School Diploma or GED 3+ years of prior authorization experience Athena EHR experience required ICD-10 and CPT coding knowledge Insurance verification experience

Responsibilities

The Botox Utilization Review Specialist is responsible for obtaining insurance authorizations for therapeutic Botox injections by reviewing medical records for clinical necessity. This role also manages the submission of authorization requests, tracks pending approvals, and handles denials and appeals.