Prior Authorization

ARIZONA SPINE AND PAIN SPECIALISTS LLC•Phoenix, AZ

About The Position

The Prior Authorization position is responsible for obtaining prior authorizations for services provided at AZ Pain Doctors, including pain management procedures and durable medical equipment (DME). The role reviews service requests and supporting documentation, submits authorizations to insurance companies, records authorization details, and coordinates with relevant staff and the ASC/Procedure Center.

Requirements

Previous experience in a medical professional atmosphere.
Oral and written communication skills.
Familiarity with CPT and ICD-10 coding concepts.
Proficiency with government and private insurance.
Understanding of insurance websites and authorization submission form fields.
Knowledge of medical and insurance terminology.
Excel and computer skills.
High school diploma or equivalent.

Nice To Haves

Experience with E-Clinical Works EMR.

Responsibilities

Determine whether authorization is required for ordered services.
Maintain current medical policies for insurance companies and track relevant changes.
Communicate important insurance information to appropriate staff.
Review procedure requests against insurance standards and use experience and general knowledge to identify authorization needs.
Review documentation or contact the provider when needed to supplement an order and demonstrate medical necessity.
Ensure documentation is complete before submitting authorizations to help avoid repeat submissions and denials.
Submit authorizations with the correct CPT and diagnosis codes.
Cross-reference assigned procedures against doctors’ orders to ensure all services are submitted correctly.
Enter authorization numbers and expiration dates into task messages for corresponding services.
Work closely with the ASC/Procedure Center.
Complete tasks by their due dates.
Verify whether blood thinner clearance is required from the patient’s PCP or cardiologist.