PRE-AUTHORIZATION SPECIALIST

ORTHOPAEDIC ASSOCIATES OF WISCONSIN • Village of Pewaukee, WI

1d • Onsite

About The Position

Summary of Role
The Pre-Authorization Specialist is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met before delivery of inpatient, outpatient, and ancillary services. This role involves coordinating with healthcare providers to secure necessary referrals.

Requirements

• High School Diploma or equivalent
• Minimum two years of experience in medical insurance verification, pre-authorization, or a related role
• Proficiency in using electronic health records (EHR) and insurance verification software.
• Ability to communicate effectively in verbal, nonverbal, and written forms.
• Strong understanding of insurance policies, pre-certification, and authorization processes.

Nice To Haves

• Experience in an orthopedic or surgical setting preferred
• Experience using EPIC and Microsoft Office preferred.

Responsibilities

• Obtain authorizations and pre-determinations from insurance companies for all required services.
• Receive verification of benefits from insurance. Confirm patient eligibility through direct communication with insurance companies and online portals.
• Enter new/updated patient information into the computer system. Ensure all necessary documentation is complete, accurate, and submitted promptly.
• Determines patient payer authorization requirements to obtain the necessary authorization. Provide updates to relevant parties regarding the status of authorizations and potential issues.
• Track the status of pre-authorizations daily. Notify administrative assistants before due dates and serve as a resource to clinical staff to facilitate timely completion.
• Responsible for documenting the appropriate information in the patient's record and ensuring referrals are in place where necessary. Maintain accurate and detailed records of all insurance verifications, authorizations, and referrals.
• Liaise with patients, healthcare providers, and insurance companies to resolve any insurance coverage and authorization issues.
• Ensure all actions comply with hospital policies, state and federal regulations, and insurance guidelines.
• Perform other office duties when backup coverage is needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED