Surgical Authorization Specialist- REMOTE (Must live in AZ Time zone)
About The Position
The Surgical Authorization Specialist is responsible for monitoring upcoming surgical cases to ensure authorizations are obtained in a timely and accurate manner. This role involves verifying patient demographic information, insurance eligibility, and coordinating benefits. The specialist will also complete surgical cost analysis forms, verify benefits for all procedures, and document authorizations in the patient's chart and case management system. Effective communication with physicians, patients, and co-workers is essential, as is maintaining strict confidentiality of health records and meeting HIPAA guidelines. The role also includes participating in staff training, responding to complaints, 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 are required.
- Strong customer service orientation is required.
- Strong background in computers and data entry is required.
- Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
- Working knowledge of Federal, state, and HIPAA privacy regulations.
- Working 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.
- 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.
- 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.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
