Job Description

Position Summary:

We are seeking a highly detail-oriented and motivated Medical Necessity Specialist to join our team at a busy pain management clinic. This entry-level role is responsible for reviewing provider documentation to ensure accuracy, completeness, and compliance with internal policies and medical necessity guidelines. Your work will directly support proper billing, insurance claims processing, and high-quality patient care.

________________________________________

Key Responsibilities:

• Review provider documentation (including visit notes, procedure reports, and diagnostic summaries) for accuracy, completeness, and medical necessity.
• Identify missing or unclear information and coordinate with providers or clinical staff for clarification or correction.
• Ensure documentation meets payer guidelines and regulatory standards for medical necessity and coding support.
• Maintain up-to-date knowledge of payer requirements and documentation standards related to pain management services.
• Assist in preparing documentation for audits, prior authorizations, or appeals, as needed.
• Track and report documentation trends or recurring issues to supervisor or quality assurance team.
• Maintain patient confidentiality and comply with all HIPAA regulations and clinic policies.

________________________________________

Job Title: Medical Necessity Specialist (Entry-Level)

Location: North Charleston, SC

Department: Pain Management

Reports To: Director of Billing

Job Type: Full-Time / Entry-Level

Compensation details: 18-24 Hourly Wage

PI0dcb6cd5265e-38003-39458922

Job Tags

Similar Jobs