Job Description

Job Description

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.

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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.

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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

Qualifications:

• High School Diploma or GED required; associate degree or certification in Health Information Management, Medical Coding, or a related field preferred.
• Experience in a healthcare or clinical documentation setting is a plus, but not required.
• Strong attention to detail and ability to identify inconsistencies or gaps in medical documentation.
• Basic understanding of medical terminology, anatomy, and healthcare procedures; familiarity with pain management a plus.
• Excellent organizational and communication skills.
• Ability to work independently and as part of a team in a fast-paced clinical environment.
• Proficient in Microsoft Office and comfortable navigating electronic health record (EHR) systems.

Compensation details: 18-24 Hourly Wage

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