Job Overview We are seeking a dedicated and detail-oriented Prior Authorization Specialist specializing in Interventional Spine / Pain Medicine to join our dynamic healthcare team. In this role, you will be responsible for managing insurance prior authorization processes to ensure timely approval of pain management treatments and procedures. Your expertise will help facilitate seamless communication between healthcare providers, insurance companies, and patients, ensuring compliance with medical and insurance policies. This position offers an engaging opportunity to contribute to patient care by streamlining authorization workflows and maintaining rigorous confidentiality standards. Responsibilities Review and process insurance prior authorization requests for pain management procedures, medications, and treatments. Collaborate with healthcare providers to gather necessary clinical documentation and ensure accurate submission of authorization requests. Verify patient insurance coverage, benefits, and eligibility using electronic health records (EHR) systems and other tools. Maintain comprehensive records of all authorization activities, including approvals, denials, and appeals. Communicate proactively with insurance companies to follow up on pending authorizations and resolve any issues promptly. Ensure compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations and clinical confidentiality policies during all interactions. Utilize medical coding skills, including CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems, to accurately document procedures and diagnoses. Assist in verifying insurance benefits related to managed care plans and health insurance policies for patients receiving pain medicine services. Support the medical office team by managing electronic health records (EHR), medical records, and billing documentation efficiently. Stay informed about updates in health insurance policies, medical billing practices, and relevant regulations affecting prior authorization processes. Skills Strong knowledge of HIPAA regulations, clinical confidentiality policies, and health information privacy standards. Proficiency in medical terminology, medical coding (CPT coding, ICD-9, ICD-10), and medical billing processes. Experience with electronic health records (EHR/EHR management) systems and Microsoft Office applications. Excellent customer service skills with the ability to communicate clearly with patients, providers, and insurance representatives. Familiarity with insurance verification procedures, managed care plans, and health insurance policy details. Prior experience in a medical office setting or dental office experience is preferred; familiarity with office workflows is essential. Ability to manage multiple tasks efficiently while maintaining attention to detail in a fast-paced environment. Knowledge of medical records management and electronic health record (EHR) systems, specifically eClinicalWorks is highly desirable. Spanish speaking preferred. Join our team as a Prior Authorization Specialist - Pain Medicine if you are passionate about improving patient outcomes through efficient administrative support while ensuring compliance with healthcare standards!

Pay:

$19.00 - $25.00 per hour

Benefits:

Paid time off

Work Location:

In person