RCM Authorizations Representative

Spire Orthopedic Partners•Stamford, CT

3d•$22 - $33

About The Position

Spire Orthopedic Partners is a national partnership of orthopedic practices that provides administrative infrastructure, capital, and operational resources to support physicians and patient care. Headquartered in Stamford, Connecticut, the network spans the Northeast and includes more than 165 physicians, 1,800 employees, 285 other clinical providers, and 40 locations in New York, Connecticut, Rhode Island, and Massachusetts. The RCM Authorizations Representative reviews EHR task lists, orders, and related dictations to determine authorization requirements for commercial surgery, physical therapy, MRI/CT scans, injections/VISCO, and DME/bone stimulators. The role maintains authorization records and task lists, documents correspondence and status updates, coordinates peer-to-peer requests, and communicates changes and scheduling needs with providers, clinical and radiology staff, and operational teams. The representative also serves as a resource for workflow and procedural issues, works with outsourced authorization companies to support contract turnaround times, and handles confidential patient data and provider correspondence accurately and professionally.

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.
Computer literacy, including practice management software, EMR, Microsoft Word, and Excel.
Strong attention to detail and 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 for authorization requests.
Keep authorization lists updated so requests are submitted on time.
Document correspondence and updates on each order as authorization status becomes available.
Notify providers, arrange peer-to-peer requests, and follow up on outcomes.
Notify clinical and radiology staff of changes to authorization requirements.
Serve as the direct point of 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.
Act as a team resource and first-line responder to procedural and workflow issues; keep staff informed about changes.
Maintain the authorization team task list.
Maintain a professional atmosphere when communicating 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 accurately and confidentially.
Serve as the main contact for provider correspondence and patient issues.
Prioritize and manage multiple tasks.