Botox Utilization Review Specialist - Phoenix, AZ

Review medical records to validate diagnoses and supporting documentation for therapeutic Botox injections, including treatments for migraines, spasms, dystonia, and hyperhidrosis. Submit prior authorization requests using appropriate ICD-10 and CPT codes while verifying medical necessity based on payer-specific clinical criteria. Coordinate with insurance carriers to confirm eligibility, benefits, and coverage limitations, then 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. Requires Athena EHR experience and 3+ years in prior authorizations.