Medical Authorizations Specialist

Premier Pain Solutions PLLC•Asheville, NC

About The Position

Premier Pain Solutions offers comprehensive and patient-centered pain management for acute and chronic pain. The interdisciplinary group of premier interventional pain management professionals provide the very best in pain relief with a whole-body health focus. The Authorizations Representative is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.

Requirements

Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
Basic understanding of human anatomy, specifically musculoskeletal
Proficient use of CPT and ICD-10 codes
Excellent computer skills including Excel, Word, and Internet use
Detail oriented with above average organizational skills
Excellent customer service skills; communicates clearly and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
High School Diploma or GED
1 years’ medical prior authorization experience preferred
2 years’ experience in a medical related field required

Responsibilities

Review chart documentation to ensure patient meets medical policy guidelines
Prioritize incoming authorization requests according to urgency
Obtain authorization via payer website or by phone and follow up regularly on pending cases
Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
Initiate appeals for denied authorizations
Respond to clinic questions regarding payer medical policy guidelines
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Contact patients to discuss authorization status
Plans and prioritizes to meet deadlines
Other duties as assigned