Surgical Prior Authorization Specialist

OrthoArizona•Peoria, AZ

16d

About The Position

OrthoArizona is a comprehensive orthopedic and podiatry practice with more than 75 providers across 30 locations, two ambulatory surgical centers, and in-house MRI capabilities. The organization emphasizes patient care, research and technology, and employee recognition. The Surgical Prior Authorization Specialist verifies authorization requirements for ordered services and procedures, ensures supporting documentation establishes medical necessity, and submits complete authorizations with accurate CPT and diagnosis codes. The role also maintains authorization and insurance information in electronic medical record systems, follows up on problem authorizations and imaging orders, maintains medical records, and estimates and collects patient payments for services. Use of state- or federally regulated websites may require personal login credentials.

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 and health insurance plans, including reading plan requirements.
Ability to understand and perform training on practice management software.
Excellent written and verbal communication skills, including effective telephone communication.
Ability to promote a favorable facility image with physicians, patients, insurance companies, and the general public.
Ability to make decisions and solve problems.
Ability to follow all Standard Operating Procedures.
Strong organizational and communication 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 obtain additional information establishing medical necessity.
Ensure documentation is complete before submitting authorizations to help avoid repeated submissions and denials.
Submit authorizations with correct CPT and diagnosis codes.
Cross-reference assigned procedures against physicians’ 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 access by corresponding departments.
Monitor and resolve problem authorizations.
Fax imaging orders to the appropriate 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 rates; prepare daily batches and deposits.