Medical Pre-certification Specialist

Company Overview
PSPM is a dedicated pain management clinic committed to providing comprehensive and compassionate care to patients. Our team specializes in delivering personalized treatment plans aimed at improving quality of life through effective pain relief strategies.

Job Overview
We are seeking a detail-oriented and proactive Prior Authorization Specialist to join our healthcare team. The ideal candidate will possess strong knowledge of managed care processes, medical office procedures, and insurance protocols. In this role, you will be responsible for obtaining prior authorizations for patient treatments, ensuring compliance with insurance requirements, referrals and facilitating smooth communication between providers, patients, and insurance companies.

Responsibilities

• Review patient records and medical documentation to determine authorization requirements for various treatments and procedures.
• Submit prior authorization requests accurately and promptly to insurance carriers, following established protocols.
• Track the status of pending authorizations and follow up regularly to ensure timely approvals.
• Communicate effectively with healthcare providers, patients, and insurance representatives to gather necessary information and resolve issues.
• Maintain detailed records of all authorization requests, approvals, denials, and related correspondence in accordance with HIPAA regulations.
• Stay updated on changes in managed care policies, CPT coding, ICD-9, ICD-10 codes, and insurance guidelines relevant to the practice.
• Assist with verifying insurance coverage and benefits for new and existing patients as needed.
• Referrals

Skills

• Strong understanding of managed care processes and insurance verification procedures.
• Proficiency in medical office software and electronic health records systems.
• Knowledge of HIPAA regulations to ensure patient confidentiality and data security.
• Familiarity with CPT coding, ICD-9, ICD-10 coding standards, and medical terminology.
• Experience with medical records management and medical coding practices.
• Excellent organizational skills with the ability to manage multiple requests simultaneously.
• Previous experience in a medical office environment is a plus. Join our team as a Prior Authorization Specialist to play a vital role in streamlining patient care processes while ensuring compliance with industry standards. Your expertise will help us deliver efficient service that enhances patient outcomes and satisfaction.

Pay: $16.00 - $18.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person