Procedure Authorization Specialist- Full time
About The Position
The Center for Orthopedic Research and Education (CORE Institute) is a highly-ranked organization, recognized by Ranking Arizona as #1 for Orthopedic Practices, #1 for Healthiest Healthcare Employers, and #3 for Best Healthcare Workplace Culture. This full-time role involves monitoring and obtaining authorizations for upcoming surgical cases, ensuring accuracy and timeliness. The specialist will verify patient demographics and insurance eligibility, complete surgical cost analysis forms, and document authorization progress. Effective communication with physicians, patients, and colleagues is essential, as is maintaining strict confidentiality of health records in accordance with HIPAA guidelines. The role also includes participating in staff training, assisting with STAT authorizations, and identifying workflow improvements.
Requirements
- Two years of experience in the healthcare field is required
- Minimum one year in Prior Auth and or Insurance verification
Nice To Haves
- previous call center experience is preferred
- Experience in Spinal Cord, Kyphoplasty and Imaging highly preferred
Responsibilities
- Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
- Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
- Accurately completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
- Verifies benefits on all surgical procedures.
- Document authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
- Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
- Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
- Work with department manager to respond to and reduce complaints timely and professionally.
- Assist surgery schedulers with STAT authorizations.
- Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
- Assists in identifying opportunities for improvement within the daily workflow process.
- Attends department meetings as required.
Benefits
- Competitive Health & Welfare Benefits
- HSA with qualifying HDHP plans with company match
- 401k plan after 6 months of service with company match (Part-time employees included)
- Employee Assistance Program that is available 24/7 to provide support
- Employee Appreciation Days
- Employee Wellness Events
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
