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