Medical Prior Authorization Specialist

Job Description

Job Description

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.

Position Highlights :

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.

Position Responsibilities :

• 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.

Required Job Qualifications :