Surgical Pre-Authorization Specialist

Nebraska Orthopaedic Center•Lincoln, NE

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.