Prior Authorization Specialist

Twin Cities Pain Clinic; Edina (MN); On-site; USD 25,000 - 39,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

401(k)

PTO

Paid holidays

HSA plan

Job summary

Twin Cities Pain Clinic is seeking a detail-oriented Prior Authorization Specialist to review insurance information, determine authorization needs, and submit requests with documentation. The role supports the business office and coordinates with insurers, physicians, patients, and vendors to ensure timely approvals.

You will manage authorizations across Medicare, Commercial, Medicaid and workers’ compensation, maintain knowledge of guidelines, and assist with denials and appeals.

Qualifications

• High School Diploma or GED required.
• Associate’s or Bachelor’s degree preferred.
• Minimum 1 year of prior authorization experience in healthcare.
• Medical terminology preferred (CPT/HCPCS, ICD-10 Codes, Procedures).
• NextGen experience preferred.

Responsibilities

• Review patient insurance information to determine if prior authorization is required.
• Manage and process authorizations for Medicare, Commercial, Medicaid and workers’ compensation for injections and procedures.
• Identify insurance coverage and coordinate pre-procedure requirements with patients.
• Communicate with insurers, physicians’ offices, vendors, and patients.
• Assist with denials and appeals and maintain authorization documentation.
• Support billing and other duties as needed.

Skills

Detail oriented

Verbal communication

Written communication

Insurance knowledge

Problem solving

Computer proficiency

Self-directed

Teamwork

HIPAA compliance

Education

High School Diploma or GED

Associate’s or Bachelor's degree preferred

NextGen experience preferred

Tools

NextGen

Job description

Position Title: Prior Authorization Specialist

Supervisor: Prior Authorization Manager

FLSA Status: Non-Exempt

Mission

To provide our patients and community the most innovative and breakthrough treatment options to improve overall health and wellness.

Values

• Innovation
• Integrity
• Patient Experience
• Teamwork

Job Summary

Working under the direction of the Prior Authorization Manager, the Prior Authorization Specialist supports the business office by reviewing patient insurance information to determine if treatments, procedures, or medications require prior authorization and preparing and submitting requests to insurance companies with necessary documentation. Duties of this role include, but are not limited to:

• Manages and processes Prior Authorizations including, but not limited to, Medicare, Commercial, Medicaid, and Worker’s Compensation for injections, procedures, and other prior authorization needs.
• Identifies insurance coverage and coordinates with patients on their pre-procedure requirements.
• Maintains working knowledge of insurance prior authorization requirements, policies, and guidelines.
• Effectively communicates with insurance companies, physicians’ offices, outside vendors, and patients.
• Acts as a resource for providers in determining patient authorization needs.
• Manages and processes authorization denials and appeals.
• Processes prior authorization paperwork.
• Facilitates prior authorization projects and tracks metrics as required.
• Cross-trains on other duties, including billing, as required.

Supervisory Responsibility

• This position has no supervisory responsibilities.

Qualifications

• High School Diploma or GED required.
• Associate’s or Bachelor’s degree preferred.
• Minimum of 1-year of prior authorization experience required in healthcare environment.
• Medical terminology preferred (CPT/HCPCS, ICD-10 Codes, Procedures, etc.).
• NextGen experience preferred.

Skills & Abilities

• Detailed oriented with ability to manage multiple priorities and work in a highly active environment.
• Strong verbal and written communication skills.
• Strong knowledge of insurance and eligibility.
• Ability to problem solve.
• Proficient computer and business skills.
• Self-directed, reliable, consistent.
• Ability to multi-task.
• Ability to work independently and with a team.
• Ability to be a professional representative of the company.
• Ability to follow directives as presented by your supervisor.
• Ability to follow company policies and procedures.
• Ability to abide by all HIPAA privacy laws.

Work Environment

While performing the duties of this job, the employee regularly works in an office setting located in Edina, MN.

This is NOT a remote role!

Physical Demands

The Physical Demands Described Here Are Representative Of Those That Must Be Met By An Employee To Successfully Perform The Essential Functions Of This Job

While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to grasp or handle objects, tools, or controls; reach with hands and arms; stoop, kneel, or crouch; talk or hear. The employee must be able to sit for 90% of the day and occasionally lift or move up to 10 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Compensation & Work Schedule

• Full-time: 40 hours/week.
• Non-Exempt.
• Day Shift: Monday – Friday, 8:30AM – 5:00PM (*hours will vary during training period).
• No evenings or weekends.
• A competitive benefits package including medical, dental, vision, life, and disability insurance, 401(k), PTO time, paid holidays, and HSA plan is offered.

No Phone Calls, Please!

All applicants must be legally authorized to work in the United States at the time of hire. Twin Cities Pain Clinic does not provide employment visa sponsorship for this position.

JOB CODE: 1000297