Surgical Prior Authorization Specialist

OrthoArizona•Peoria, AZ

16d

About The Position

OrthoArizona is a privately owned orthopedic practice serving orthopedic and podiatry needs throughout the Valley. The organization has more than 75 providers across 30 locations, two ambulatory surgical centers, and in-house MRI capabilities. OrthoArizona emphasizes patient care, research and technology, and employee recognition. The Surgical Prior Authorization Specialist verifies insurance authorization requirements for ordered services and procedures, ensures supporting documentation is complete, submits accurate authorizations, and tracks and resolves authorization issues. The role also updates authorization information and insurance notes in EMR systems, coordinates imaging orders with facilities, maintains medical records, and estimates and collects patient payments. The position requires strong customer service, communication, organization, decision-making, and knowledge of healthcare administration, medical terminology, insurance plans, and authorization processes.

Requirements

High school diploma or GED.
At least 2 years of experience in healthcare administration or a related field.
Excellent customer and patient service skills.
Knowledge of medical terminology and insurance authorization processes.
Working knowledge of computer programs.
Excellent written and verbal communication skills, including effective telephone communication.
Ability to understand and perform training on practice management software.
Ability to promote a favorable facility image with physicians, patients, insurance companies, and the general public.
Ability to make decisions and solve problems.
Working knowledge of health insurance plans, including how to read plan requirements.
Ability to follow all Standard Operating Procedures.
Strong organizational skills.
Ability to work independently and as part of a team.

Responsibilities

Verify insurance authorization requirements for ordered services and procedures.
Review documentation or contact providers to supplement orders and establish medical necessity.
Ensure documentation is complete before submitting authorizations to insurers.
Submit authorizations with correct CPT and diagnosis codes.
Cross-reference assigned procedures against doctors’ orders to ensure services are submitted correctly.
Enter authorization numbers and expiration dates into the EMR for claim processing.
Update relevant insurance notes in multiple EMR systems for department access.
Monitor and resolve problem authorizations.
Fax imaging orders to facilities and follow up to ensure patients are scheduled.
Maintain medical records in accordance with practice policies and procedures.
Estimate prepayment amounts and collect coinsurance, copayments, deductibles, or estimated self-pay amounts.
Prepare daily batches and deposits.