Surgical Authorization Specialist
About The Position
This role is responsible for monitoring and obtaining authorizations for upcoming surgical cases, ensuring they are processed in a timely and accurate manner. The specialist will verify patient demographic and insurance information, complete surgical cost analyses, and document authorization progress. Effective communication with physicians, patients, and colleagues is essential, as is maintaining strict confidentiality of health records and adhering to HIPAA guidelines. The position also involves participating in staff training, assisting with STAT authorizations, and identifying workflow improvements.
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.
- 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.
- Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
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.
- Completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
- Verifies benefits on all surgical procedures.
- Documents authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
- Communicates effectively with physicians, patients, and co-workers and establishes good working relationships with both internal and external customers.
- Participates in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
- Works with the department manager to respond to and reduce complaints timely and professionally.
- Assists surgery schedulers with STAT authorizations.
- Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines.
- Assists in identifying opportunities for improvement within the daily workflow process.
- Attends department meetings as required.
Benefits
- Competitive Health & Welfare Benefits
- Monthly $43 stipend to use toward ancillary 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 Wellness Events
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
