RCM Authorizations Representative

Spire Orthopedic Partners•Stamford, CT

About The Position

Spire Orthopedic Partners is a national partnership of orthopedic practices and a Management Services Organization (MSO) that provides administrative infrastructure and operational resources to support physician practices. The network spans the Northeast and includes more than 165 physicians, 1,800 employees, 285 other clinical providers, and 40 locations across New York, Connecticut, Rhode Island, and Massachusetts. The RCM Authorizations Representative reviews EHR tasks, orders, and dictations to identify authorization requirements for commercial surgery, physical therapy, MRI/CT scans, injections/VISCO, and DME/bone stimulators. The representative maintains task lists and order records, documents communications and status updates, coordinates peer-to-peer requests, and informs providers and clinical and radiology staff of authorization changes. The role also serves as a contact for outsourced authorization companies, coordinates scheduling needs with operational staff, supports team workflow, and works with RCM and operational teams to support appropriate scheduling and patient care. The position handles confidential patient data in the EMR and requires accuracy, professionalism, prioritization, and multitasking.

Requirements

At least one year of prior authorization experience.
High school diploma or equivalent.
Excellent telephone etiquette and written and oral communication skills.
Familiarity with Local Coverage Insurance Plans.

Nice To Haves

Knowledge of orthopedic procedures; helpful but not essential.
Computer literacy, including practice management software, EMR, Microsoft Word, and Excel.
Attention to detail and strong organizational skills.

Responsibilities

Review EHR task lists to determine authorization requirements for commercial surgery, physical therapy, MRI/CT scans, injections/VISCO, and DME/bone stimulators.
Review orders and necessary dictations in the EHR related to authorization requests.
Keep authorization lists current so requests are submitted in a timely manner.
Document correspondence and updates on each order as authorization status becomes available.
Notify providers and arrange peer-to-peer requests, then follow up on their outcomes.
Notify clinical and radiology staff of changes to authorization requirements.
Serve as the direct contact for outsourced authorization companies and ensure appropriate turnaround times are supported per contract.
Communicate scheduling needs with the Director of Operations, office managers, and PCCs.
Serve as a resource for the team and respond to procedural and workflow issues, keeping staff informed of changes.
Maintain the authorization team task list.
Maintain a professional work atmosphere in interactions with patients, physicians, coworkers, and administration.
Work with RCM and operational teams to support proper scheduling and patient care, including monitoring team communication and decision-making.
Create, update, and access confidential patient data in the EMR with a high level of confidentiality and accuracy.
Serve as the main contact for provider correspondence and patient issues.
Prioritize and manage multiple tasks.