Prior Authorization Specialist

Company Overview:

Commonwealth Pain & Spine is a pain management network dedicated to improving the lives of our patients by treating their pain with the utmost respect and providing them with the most innovative, safe, responsible, and clinically proven pain relief possible. Our team of best-in-class physicians, administrators, and staff empathizes with the needs of our patients. We recognize that their pain is exhausting and debilitating and limits their quality of life. Relief from chronic pain is achievable in various degrees through our intelligent and multimodal team-based approach. Our entire team is committed to providing levels of patient satisfaction and overall clinical outcomes that far exceed the expectations of the medical community, referring physicians, and our customers.

Job Summary:

The Prior Authorization Specialist is responsible for all aspects of the prior authorization process. Responsibilities include collecting all the necessary documentation, contacting the client for additional information and completion of the required prior authorization order. Complete, timely, and accurate identification and submission of prior and retro authorization requests to the payors. Interacts with clients, insurance companies, patients, and sales representatives, as necessary, to request for prior authorizations.

Job Duties & Responsibilities:

• Works with departments and insurance companies to obtain the necessary pre-certifications, authorizations and referrals for services ordered/scheduled

• Maintains a high level of understanding of insurance companies and billing authorization/referral requirements

• Ensures insurance carrier documentation requirements are met, and authorization documentation is scanned and documented in the patient’s medical record

• Communicates with other prior authorization/referral specialists, patient account representatives and coders to continually monitor changes in the health insurance arena

• Reviews and submits all follow-up authorizations, recertifications and referrals.

• Appeals denials and/or set-up peer to peer reviews

• Pre-screens appointment schedules and works 1-2 weeks out with provider schedules along with checking daily add-ons

• Maintains an approachable and appropriate attitude when interacting with all levels of personnel in a rapidly changing environment

• Eagerness and ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects

• Supports the vision and culture of the organization. Demonstrates personal commitment through active involvement in the performance improvement process

• Adheres to the Employee Handbook and Policies and Procedures

• All other duties assigned including duties performed for affiliates, assigns, lessees, contractors or other third parties

Required Skills & Abilities:

• Exceptional communication and interpersonal skills to interact effectively and tactfully with all levels of employees, management staff, patients, vendors and the general public

• Strong computer and phone skills, including Microsoft Office Suite experience

• Responds timely to requests, emails, voicemails, etc.

• Ability to handle multiple simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner

• High integrity, including maintenance of confidential information

• Regular and reliable attendance

• Exercises professional judgment and demonstrates good problem-resolution skills

• Eagerness and ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects

Education & Experience:

• Must have high school diploma or general education degree (GED)

• Two years’ relevant Pain Management or Ortho work experience in obtaining prior authorizations and referrals, preferred

• Knowledge of reimbursement and claims processing procedures to include billing and collection practices

• Basic CPT and ICD-10 coding knowledge

• Working knowledge of EMR and/or billing systems, athenahealth preferred

• General knowledge of injection prior authorizations, preferred

Commonwealth Pain & Spine is an equal opportunity employer.