Surgery Scheduler and Prior Authorization Specialist

EPIC Health System•Southfield, MI

23d•Onsite

About The Position

Epic Health is seeking a dedicated and detail-oriented Surgery Scheduler and Prior Authorization Specialist to join our Perioperative team. This role coordinates scheduling of surgical procedures and obtains necessary authorizations from insurance companies to ensure a smooth, timely surgical experience for patients and providers. The role requires strong knowledge of medical terminology, CPT/ICD coding basics, insurance verification processes, and proficiency with EHR and practice management systems.

Requirements

High school diploma or GED required
Minimum 2 years experience in medical scheduling, prior authorizations, or related healthcare administrative role.
Working knowledge of medical terminology, CPT and ICD-10 coding fundamentals applicable to surgical procedures.
Demonstrated experience with insurance verification, prior authorization submissions, and payer communications.
Proficiency with Electronic Health Record (EHR) systems and scheduling software
Excellent verbal and written communication skills
Strong customer service and patient-facing experience.
Strong organizational skills with the ability to multitask, prioritize, and meet deadlines in a fast-paced environment.
High attention to detail and accuracy when entering authorization details and schedule information.

Nice To Haves

Associate's degree or healthcare certificate preferred.
Experience with Athena or similar systems preferred.
Previous experience as a Medical Assistant, Surgical Scheduler, or in a hospital/ASC scheduling office preferred.
Familiarity with payer portals, electronic prior authorization platforms, and standard appeal processes.
Certification in medical billing/coding (CPC, CCA) or prior authorization specialist certification is a plus.
Bilingual (Spanish/English) highly desirable for patient communication in our service area.

Responsibilities

Schedule surgeries, pre-op appointments, and post-op follow-ups according to physician orders, surgeon availability, and facility protocols.
Coordinate with patients, surgeons, anesthesiologists, nursing staff, and facility teams to confirm dates, times, and pre-operative instructions.
Obtain prior authorizations for surgical procedures, durable medical equipment, and related services through timely submission to payers.
Verify patient insurance coverage and eligibility; determine benefit details, copays, deductibles, and out-of-pocket responsibilities.
Prepare and submit complete authorization packets including clinical documentation, operative indication, and supporting diagnoses/CPTs.
Track authorization status; follow up on pending/denied requests; appeal denials as needed in coordination with Revenue Cycle.
Maintain accurate and up-to-date authorization records in the EHR and scheduling systems; update patient charts with authorization numbers and notes.
Ensure required consents, pre-op clearances, and necessary diagnostic testing are completed prior to the surgery date.
Communicate clearly and compassionately with patients regarding scheduling timelines, authorization status, financial responsibility, and pre-op instructions.
Collaborate with the prior authorization team, billing, and clinical staff to streamline workflows and reduce denial rates.
Monitor and report scheduling and authorization KPIs (authorization turnaround, denial rate, on-time case starts) to manager.
Participate in continuous improvement initiatives to improve scheduling efficiency, authorization accuracy, and patient experience.