Prior Authorization Specialist

BoulderCentre for Orthopedics and Spine•Boulder, CO

1d•$20 - $29

About The Position

Job Overview: Join our medical billing team as an Authorization Specialist. This role includes verifying insurance benefits, obtaining pre-certifications and authorizations from payors, submitting necessary documentation, and assisting patients with understanding their financial obligations. The specialist will monitor the authorization status of scheduled patients and reschedule appointments as necessary pending completed authorization.

Requirements

High school diploma or GED required. College degree preferred.
Minimum of 2 years of experience in medical billing/authorization.
Familiarity with pre-authorization, pre-certification, and health insurance claims processing
Knowledge of insurance processes, third-party payers, basic coding (CPT, ICD-9), Medicare compliance, OSHA, HIPAA, and relevant regulations.
Skills in written and verbal communication, customer service, math, and organization.
Ability to prioritize tasks, multitask, and work effectively in a fast-paced environment while maintaining cooperative relationships with staff and patients.

Nice To Haves

Experience in an orthopedic setting preferred.

Responsibilities

Submit and follow up on authorization requests with insurance companies for internal MRI, therapy, surgery, and DME orders.
Verify order contents and insurance coverage upon receipt, obtain pre-authorization, and communicate benefits eligibility and financial details to patients and practitioners.
Notify patients and practitioners of any services requested that are not authorized by insurance.
Review upcoming schedules for authorization status and contact patients with payment/rescheduling options if authorization is not obtained.
Utilize intraoffice communication and resources to support the authorization process.
Prioritize workflow based on authorization timeframes, insurance requirements, and urgency.
Obtain retroactive authorizations as needed.
Maintain accurate and timely documentation and records for continuity of patient care.
Perform other duties as assigned.

Benefits

Basic Life/AD&D –Guardian
16 days of PTO per year
7-7.5 paid holidays per year
Employee Assistance Program
401(k) Safe Harbor Contribution
Medical
Health Savings Account
Dental
Vision
Short-Term Disability
Voluntary Life and AD&D
Flex Spending Accounts
General Purpose Healthcare FSA
Optional Protection Benefits (Accident, Hospital Indemnity, Cancer Care and Critical Illness Insurance)
401(k)