Medical Prior Authorization Specialist

Company Overview

Modern Pain Consultants is a renowned Interventional Pain Practice committed to providing exceptional patient care and innovative pain management solutions. We are a well-established, higher volume Interventional Pain Practice seeking a seasoned, talented full-time Prior Authorization Specialist with a can-do attitude and strong professionalism. You must be computer savvy for this position. We are EMR – based, using EMA;
Experience with EMA is very beneficial, but not required. Looking for candidates who want a long-term, stable position with opportunity for advancement.

The Prior Authorization Specialist is responsible for obtaining and resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all payers. In addition, the Prior Authorization Specialist may be responsible for pre-appointment registration and insurance review to maximize the submission of a clean claim.

• Reviews, collects and properly records demographic and insurance information required to properly address the customers  authorization requirements and identify any financial issues. Verifies patient s eligibility from resources provided by third party payers and portals and other on lines services.
• Collects and analyzes demographic, insurance and other information from the patient, guarantor and all other sources to accurately obtain authorization for scheduled procedure.
• Assembles information concerning the patient s clinical background and clinical information that is required for the payer to issue a referral or an authorization. Per referral guidelines, provide appropriate clinical information to the payer.
• Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, CPT codes and clinical notes.
• Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including HIPAA privacy.
• Consistently maintains authorization accuracy rates at and or above department standard in performance of registration and authorization duties.
• Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.
• Receives and properly responds to, or directs telephone and electronic inquiries from patients, payers, physicians and their staff, internal department and other persons and entities.
• Ability to exercise good customer service skills when communicating with both our patients as well as our internal customers.
• Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.
• Performs other duties as assigned for the operational effectiveness and success of the department.

• High school graduate or equivalent.
• 1 year of experience
• Excellent communication and outstanding customer service and listing skills.
• Basic keyboarding skills
• Ability to analyze and interpret data
• Critical thinking, sound judgment and strong problem-solving skills essential
• Team oriented, open minded, flexible, and willing to learn
• Strong attention to detail and accuracy required
• Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
• Ability to follow oral and written instructions and established procedures
• Ability to function independently and manage own time and work tasks
• Ability to maintain accuracy and consistency
• Ability to maintain confidentiality
• Experience in Pain Specialty is Preferred