Surgical Pre-Authorization Specialist

Nebraska Orthopaedic CenterLincoln, NE
4d

About The Position

We always strive to make your experience at Nebraska Orthopaedic Center a friendly, comfortable, and positive one. We want you to feel you received the same high-quality care we would offer a member of your own family. At NOC, we strive to be your healing destination.

Requirements

  • High school diploma or GED.
  • Knowledge of insurance pre-authorization requirements.
  • Knowledge of medical terminology, diagnosis, and procedure codes.
  • Skill in problem solving, decision-making, and in dealing effectively with staff, patients, hospitals, insurance companies and the public.
  • Skill in using office equipment (i.e. computer, fax, scanner, copier).
  • Ability to maintain accurate information and documentation.
  • Ability to organize time and tasks appropriately.

Nice To Haves

  • One year's experience in a health care organization is preferred.

Responsibilities

  • Obtains, reviews and organizes all scheduled surgeries.
  • Prioritize work based on date of service.
  • Monitors surgery schedules for additions, changes, and cancellations.
  • Obtains and reviews surgical orders from NOC clinic staff through the EMR.
  • Ensure CPT codes are accurate, and surgical orders align with physician notes and treatment plans; verify with surgical coding team when necessary.
  • Communicates with clinical staff, transcription, hospitals, and surgery centers when additional information is required.
  • Contacts insurance companies, workers’ compensation carriers, and third-party liability carriers to obtain pre-authorizations and medical policy information.
  • Submits physician notes, PT notes, reports, and other required documentation for authorization.
  • Faxes or electronically submits records and reports as requested.
  • Monitors pending authorizations and follow up as needed.
  • Attaches authorization approvals and denials in the patient EMR and surgery case.
  • Communicates approvals/denial updates to the clinical team.
  • Facilitates peer-to-peer review requests by communicating the information to the physician scheduler or clinical team.
  • Submits appeal letters once completed by a physician.
  • Notifies insurance companies, workers’ compensation and third-party liability carriers for surgical changes and cancellations.
  • Responds to all phone calls and emails from hospitals and surgery centers regarding pre-authorizations.
  • Escalates issues to management when appropriate.
  • Maintains regular and reliable attendance as an essential function of the position.

Benefits

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Employee assistance program
  • Flexible spending account
  • Free parking
  • Health insurance
  • License reimbursement
  • Life insurance
  • Paid time off
  • Tuition reimbursement
  • Vision insurance
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