Prior Authorization Specialist at Twin Cities Pain Clinic Minneapolis, MN

Twin Cities Pain Clinic; Minneapolis (MN); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

401(k) plan

Paid time off

HSA plan

Job summary

Healing Strides Counseling in Minneapolis is seeking a Prior Authorization Specialist to support the business office by reviewing patient insurance information and preparing submissions for prior authorizations.

The role manages authorizations across Medicare, Commercial, Medicaid, and Worker's Compensation, coordinates with patients on pre-procedure requirements, and communicates with insurers, providers, and vendors while handling denials and appeals.

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.

Responsibilities

• Reviews patient insurance information to determine if treatments require prior authorization.
• Manages and processes Prior Authorizations for Medicare, Commercial, Medicaid, and Worker's Compensation.
• Identifies insurance coverage and coordinates with patients on pre-procedure requirements.
• Maintains knowledge of insurance prior authorization requirements, policies, and guidelines.
• Communicates with insurance companies, physicians' offices, outside vendors, and patients.
• Assists with authorization denials and appeals and tracks metrics as required.
• Cross-trains on other duties, including billing, as required.

Skills

Attention to detail

Communication skills

Problem solving

Independent work

Education

High School Diploma or GED

Associate's or Bachelor's degree preferred

Tools

NextGen

Job description

Prior Authorization Specialist

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.
• 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.

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.

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.

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.