Prior Authorization Specialist

Twin Cities Pain Clinic•Edina, MN

7d•Onsite

About The Position

Under the direction of the Prior Authorization Manager, the Prior Authorization Specialist supports the business office by reviewing patient insurance information to determine whether treatments, procedures, or medications require prior authorization. This role is responsible for preparing and submitting authorization requests to insurance companies, ensuring all required documentation is complete and accurate.

Requirements

High School Diploma or GED required.
Strong attention to detail with the ability to manage multiple priorities in a fast-paced environment.
Excellent verbal and written communication skills.
Solid understanding of insurance coverage and eligibility processes.
Strong problem-solving and critical-thinking abilities.
Proficiency in computer systems and standard business software.
Self-motivated, reliable, and consistent work ethic.
Ability to multitask and work both independently and collaboratively within a team.
Professional demeanor and ability to represent the organization effectively.
Ability to follow supervisor directives and adhere to company policies and procedures.
Commitment to maintaining confidentiality and compliance with HIPAA regulations.

Nice To Haves

Associate’s degree preferred.
Minimum of one (1) year of prior authorization experience in a healthcare setting preferred.
Familiarity with medical terminology, including CPT/HCPCS codes, ICD-10 codes, and procedures preferred.
Experience with NextGen or similar electronic health record (EHR) systems preferred.

Responsibilities

Manage and process prior authorizations for Medicare, Commercial, Medicaid, and Workers’ Compensation cases, including injections, procedures, and other services requiring approval.
Review and verify patient insurance coverage and coordinate with patients regarding pre-procedure requirements.
Maintain up-to-date knowledge of insurance prior authorization requirements, policies, and guidelines.
Communicate effectively with insurance companies, physician offices, external vendors, and patients.
Serve as a resource for providers in determining authorization requirements for patient care.
Manage authorization denials and coordinate the appeals process as needed.
Complete and maintain accurate prior authorization documentation and records.
Support prior authorization-related projects and track performance metrics as required.
Cross-train and assist with additional duties as assigned.