Surgical Authorization Specialist
About The Position
The Surgical Authorization Specialist is responsible for monitoring upcoming surgical cases, ensuring timely and accurate authorization of surgeries. This role involves verifying patient demographics and insurance eligibility, completing cost analysis forms, and documenting authorization progress. The specialist will also communicate effectively with physicians, patients, and co-workers, participate in staff training, and assist with STAT authorizations. Maintaining strict confidentiality of health records and meeting HIPAA guidelines are essential. The role also includes identifying workflow improvements and attending department meetings.
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
- High school diploma/GED or equivalent working knowledge preferred.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
