What are the responsibilities and job description for the Experienced Prior Authorizations Specialist - Pain Management position at Envision Pain Management?
About Us
At Envision Pain Management, we provide a comprehensive, patient-centered approach to pain management—combining advanced procedures, therapies, and diagnostics to help patients get back to living their lives. Our team of specialists focuses on minimally invasive treatments, personalized care plans, and compassionate support for patients dealing with chronic pain.
Job Summary
We are seeking a detail-oriented Prior Authorization Specialist to join our growing team in western North Carolina. This role is critical in ensuring patients receive timely care by securing insurance authorizations for procedures, diagnostic testing, and treatment plans.
If you thrive in a fast-paced medical environment and understand the importance of accuracy and urgency, this is a great opportunity to directly impact patient care.
Typical Duties
- Verify patient insurance benefits, eligibility, coverage details and clinical information to ensure that all reimbursement requirements are met.
- Obtain prior authorizations for procedures, injections, imaging, and therapies
- Notifies the necessary parties within the required timeframe for routine and urgent requests for services.
- Communicates with patients and/or referring physicians on non-covered benefits or procedure coverage issues.
- Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
- Ensures insurance carrier documentation requirements are met and authorization documentation is entered and recorded in the patient's records.
- Appeals pre-authorization denials and/or set-up peer to peer reviews.
- Stay up-to-date with insurance policies, payer requirements, and industry regulations impacting prior authorizations
- Collaborate with billing, clinical, and patient services teams to ensure seamless coordination of care and reimbursement
- Monitor authorization trends and provide reports to management to support workflow improvements
- Builds and maintains working relationships with staff, referral sources, insurance companies, and medical providers.
- All other duties as requested
Minimum Qualifications
- High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Nursing, or related field preferred
- 2 years of experience in medical prior authorizations (pain management, orthopedics, or specialty care preferred)
- Strong knowledge of insurance plans, CPT/ICD-10 coding, and medical terminology
- Experience working with procedures such as injections, imaging, or specialty treatments preferred
- Experience using electronic medical records systems (Athena)
Knowledge, Skills, Abilities and Other Characteristics
- Proficiency with Microsoft applications and internet-based programs
- Strong interpersonal skills with the ability to establish strong working relationships
- Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
- Strong time management skills to prioritize assignments and meet the designated deadline. Ability to anticipate, recognize, and meet the needs of the patients and their families
- Ability to work in a team-based environment to accomplish goals and objectives
- Ability to critically think, problem solve and make independent decisions supporting the authorization process, including interactions with payer representatives, physicians, and hospital case managers
- Ability to act with integrity, professionalism, and confidentiality adhering to all HIPAA standards
Why Join Us
- Work with a collaborative, patient-focused care team
- Be part of a growing specialty practice with multiple North Carolina locations
- Opportunity to make a meaningful impact on patient access to care
- Competitive benefits package; pay dependent upon experience
Company Description
Envision Pain Management uses a comprehensive approach to pain and spine care. Our physicians are board-certified and fellowship-trained in interventional pain medicine.