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York Pain Center

Prior Authorization Specialist

Career Insights for Medical Claims Processor / Representative

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Based on Pennsylvania data

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What they do

A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.

$42,879 / year median in Pennsylvania

-5% projected decline

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Job Description

At York Pain Center, and the Broad Street Pain Center we are dedicated to providing exceptional, patient-centered care in the field of pain management. Our team is committed to helping patients achieve better quality of life through innovative and compassionate care.
Position Summary:
We are seeking a detail-oriented and proactive Prior Authorization & Precertification Specialist to join our administrative team. This role is critical in ensuring timely approvals for patient procedures and treatments, coordinating with insurance providers, and supporting our clinical staff in delivering seamless patient care.
Key Responsibilities:
Obtain prior authorizations and precertifications for procedures, medications, and imaging. Verify patient insurance benefits and eligibility. Communicate effectively with insurance companies, physicians, and patients regarding approvals and denials. Track authorization status and follow up as needed to ensure timely processing. Maintain accurate and organized records in the electronic health record (EHR) system. Collaborate with clinical, billing, and administrative staff to ensure compliance with insurance guidelines and regulations.
Qualifications:
High school diploma or equivalent; associate's degree or higher preferred. Prior experience in prior authorization, precertification, and insurance verification is required. Knowledge of insurance plans, CPT/ICD-10 coding, and prior authorization processes. Strong organizational skills and attention to detail. Excellent communication and interpersonal skills. Ability to manage multiple tasks and prioritize effectively in a fast-paced environment.
Job Type:
Full-time Pay:
$18.00 - $24.00 per hour
Benefits:
401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Retirement plan Vision insurance
Work Location:
In person