Surgical Navigator ASC

CPS•Louisville, KY

4d•Remote

About The Position

The Surgical Navigator serves as the centralized coordinator for ASC surgical/procedural scheduling, physician order management, payer medical necessity review, prior authorization/precertification, medical clearance coordination, financial clearance, patient scheduling and registration in SIS, and procedural order management within AthenaOne. This role ensures every procedure is clinically, financially, and operationally ready prior to the date of service while serving as the primary liaison between providers, patients, ASC staff, and payers.

Requirements

High school diploma required; Associate's or Bachelor's degree preferred.
Three or more years of ASC, surgery scheduling, authorization, or procedural coordination experience.
Knowledge of Medicare, Medicaid, and commercial payer requirements.
Experience with CPT, ICD-10-CM, HCPCS, AthenaOne, and/or SIS preferred.
Excellent organizational, communication, and customer service skills.

Responsibilities

Review and validate physician procedure orders.
Ensure complete documentation supports medical necessity.
Review payer-specific coverage, LCD/NCD, and commercial policies.
Obtain prior authorizations, precertification's, referrals, and notifications.
Coordinate peer-to-peer reviews and appeals when needed.
Coordinate all required medical clearances (PCP, cardiology, pulmonary, labs, EKGs, imaging, anticoagulation, etc.).
Verify insurance eligibility and benefits.
Conduct patient financial clearance and discuss estimated responsibility.
Schedule and register patients accurately in SIS.
Manage procedure orders and workflow within AthenaOne.
Maintain worklists and documentation through completion.
Coordinate with providers, anesthesia, vendors, and ASC leadership.
Educate patients regarding procedure preparation and financial expectations.
Maintain compliance with CMS, payer, HIPAA, and accreditation requirements.