Flagler Health Is Building The Clinical Operating System For Modern Musculoskeletal CareWe 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 and are entering our next phase of growth.Role OverviewFlagler 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 DoingYou will help ensure providers receive timely authorization approvals by managing the full lifecycle of prior authorization workflows.Procedural AuthorizationsSubmit and manage prior authorizations for pain management and orthopedic procedures, including:Epidural steroid injectionsFacet injectionsRadiofrequency ablation (RFA)SI joint injectionsAdvanced imaging (MRI, CT)Orthopedic surgical proceduresPrescription Drug AuthorizationsManage prior authorizations and reauthorizations for medications commonly used in pain managementNavigate pharmacy benefit portals and step-therapy requirementsSubmit formulary exception and medical necessity documentation when requiredAuthorization ManagementNavigate multiple payer portals efficientlyVerify insurance eligibility and benefits prior to submissionReview provider documentation to confirm medical necessity and procedural alignmentFollow up on pending or denied authorizationsIdentify documentation gaps before submission to reduce preventable denialsMaintain clear documentation within EHR and tracking systemsSupport billing and reconciliation activities as needed, including resolving authorization-related billing issuesThis role requires strong workflow discipline, attention to detail, and the ability to manage a high volume of requests accurately.Required Qualifications3+ years of prior authorization experience in Pain Management or OrthopedicsDemonstrated experience with: Interventional pain and/or orthopedic surgical authorizationsPrescription 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 volumeHands-on experience with payer portals (e.g., Availity, UHC, Carelon/AIM, eviCore, Cohere, CoverMyMeds, etc.)Strong working knowledge of CPT codes and procedural terminologyExperience reviewing documentation for medical necessityExceptional attention to detail and follow-throughStrongly PreferredExperience with Medicaid plans, including AHCCCSCPC-A or other coding certificationFamiliarity with NCCI edits, bundling rules, and step therapy protocolsExperience identifying recurring denial patterns and process gapsWhat Success Looks LikeStrong first-pass approval ratesMinimal preventable authorization-related denialsConsistent, timely submissionsClear documentation and communicationIndependent execution with limited supervisionOur ValuesThis is what you can expect of your teammates at Flagler:Persistence + ownership of outcomes: We wear many hats and aren't afraid to run through walls to solve hard problems.Personal + professional growth: We push ourselves to learn new things and embrace challenges, even if it means that we sometimes fail.Don't take things personally: We value and react quickly to constructive feedback.Speed is our ally: In the fast-paced world of startups, we understand the value of moving swiftly. We thrive on the adrenaline of working rapidly.Be right: We are highly detailed oriented and try to be right, a lot.