Surgical Authorization Specialist

Seeking immediate hire to join our Business Office as an Authorization Specialist in a high-profile Sports Medicine Group supporting 15 physicians and 6 clinic locations.

DUTIES INCLUDE, BUT ARE NOT LIMITED TO:

• Interpret insurance benefits and calculate patient responsibility
• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorizations via payer portals or by phone and follow up regularly on pending cases
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients to discuss authorization status
• Other duties as assigned

Qualifications:

• Knowledge of commercial and governmental insurance plans (HMO, PPO, EPO, etc.) and payer portals
• Knowledge of NextGen EHR software (preferred)
• MS Office, basic office support skills (telephone, filing, data entry) and basic math skills.
• Excellent telephone etiquette, pleasant personality and customer service skills.
• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
• Plans and prioritizes to meet deadlines

EXPERIENCE: Previous experience in a similar role required.

• 2 years medical prior authorization and verification experience required
• 2 years’ experience in a medical related field required

High school diploma or GED required

Job Type: Full-time – Monday through Friday with a few rotating Saturday mornings. Traveling involved from one clinic to another based on schedule. Dependable transportation required.

Great benefits: Medical, Dental, Vision, Short Term Disability, Long Term Disability, Life Insurance and 401K.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Medical Specialty:

• Medical-Surgical

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• Weekend availability

Education:

• High school or equivalent (Required)