Prior Authorization Specialist - Pain Management

MyMichigan Health; Alpena (MI); On-site; USD 42,000 - 64,000; Full time

Job summary

MyMichigan Health is seeking a Pre-certification/Denials Specialist to obtain prior authorizations for procedural orders and communicate with clinic staff, providers and scheduling. The role serves as a liaison with third-party insurers to stay current on referral procedures and manages denials and appeals as needed.

The ideal candidate has 2–4 years of medical office experience, strong knowledge of payer policies, and solid communication skills.

Qualifications

• Two to four years medical office experience with knowledge in payer medical policy guidelines.
• Excellent interpersonal/customer relations skills and ability to work independently.
• Advanced medical terminology, knowledge of obtaining prior authorizations, ICD9/ICD10, CPT coding.
• Experience within physician practice and knowledge of third payer rules, and medical record charting/documentation experience.
• Clinical experience preferred.
• Strong written and verbal communication skills.
• Proficient computer user; experienced in Windows, Word Processing, and medical practice software.

Responsibilities

• Completes prior authorizations related to Pain Management procedures; collaborates with providers and staff to finalize third party referrals.
• Reviews chart documentation to ensure policy guidelines, prioritizes requests by urgency, obtains authorization via payer websites or phone and follows up until complete.
• Maintains payer files with up-to-date requirements, initiates appeals for denials, responds to clinic questions, and confirms CPT/ICD codes in procedures orders.

Skills

Medical office experience

Payer policy knowledge

Interpersonal skills

Medical terminology

ICD-9/ICD-10 coding

CPT coding

EPIC EMR experience

Windows proficiency

Communication skills

Education

High School Diploma or GED

Tools

EPIC EMR

Microsoft Word

Job description

MyMichigan Health is seeking a Pre-certification/Denials Specialist to obtain prior authorizations for procedural orders and communicate with clinic staff, providers and scheduling. The role serves as a liaison with third-party insurers to stay current on referral procedures and manages denials and appeals as needed.

The ideal candidate has 2–4 years of medical office experience, strong knowledge of payer policies, and solid communication skills.