Surgical Authorization Specialist

Healthcare Outcomes Performance Company•Phoenix, AZ

37d

About The Position

The Surgical Authorization Specialist is responsible for monitoring upcoming surgical cases on physician calendars to ensure timely and accurate authorization of surgeries. This role involves verifying patient demographics and insurance eligibility, coordinating benefits, and updating information for claim processing. The specialist will also complete surgical cost analysis forms, document authorization progress in patient charts and case management systems, and communicate effectively with physicians, patients, and coworkers. Additionally, the role includes participating in staff training, responding to complaints, assisting with STAT authorizations, maintaining strict confidentiality of health records in compliance with HIPAA, and identifying workflow improvement opportunities. The specialist will attend department meetings as required.

Requirements

A minimum of 2 years of experience in the healthcare field is required.
Excellent organizational skills and strong customer service orientation are required.
Strong background in computers and data entry.
Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
Knowledge of Federal, state, and HIPAA privacy regulations.
Knowledge of computer applications.
Skill in effective organization and billing requirements and authorization processes.
Skill in using computer programs and applications including Microsoft Excel, Microsoft Word, and Outlook.
Skill in establishing good working relationships with both internal and external customers.
Ability to multi-task in a fast-paced environment.
Must be detailed oriented with strong organizational skills.
Ability to understand patient demographic information and determine insurance eligibility.
Ability to work independently and demonstrate the ability to analyze data.
Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.

Nice To Haves

Previous experience in referrals/authorizations, front office, and/or charge posting is 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.
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.