Medical Authorizations Specialist at Premier Pain Solutions PLLC – Greenville, South Carolina

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.

Essential 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

• 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

Education and Experience:

• High School Diploma or GED
• 1 years’ medical prior authorization experience preferred
• 2 years’ experience in a medical related field required