Procedure Authorization Specialist

4 weeks ago

Jacksonville, United States Center for Orthopedic and Research Excel Full time
Job DescriptionJob Description

Southeast Orthopedic Specialists is a leading provider of comprehensive orthopedic care in the Southeast region. We are committed to delivering exceptional patient-centered care and improving the quality of life for our patients through advanced orthopedic treatments.

Benefits:

  • Competitive Health & Welfare Benefits
  • Monthly $43 stipend to use toward ancillary benefits
  • 401k plan
  • Employee Assistance Program that is available 24/7 to provide support
  • Employee Appreciation Days

As a Procedure Authorization Specialist at Southeast Orthopedic Specialists, you will be responsible for obtaining insurance pre-authorizations and verifying coverage for medical procedures. You will work closely with healthcare providers, insurance companies, and patients to ensure timely approvals and accurate billing. This role requires attention to detail, excellent communication skills, and a strong understanding of medical insurance processes.

Key Responsibilities:

  • Obtain pre-authorizations from insurance companies for orthopedic procedures and treatments.
  • Verify patient insurance coverage and benefits for planned procedures.
  • Communicate with healthcare providers to gather necessary clinical information for authorization requests.
  • Submit authorization requests accurately and in a timely manner.
  • Follow up with insurance companies and providers to track the status of authorization requests.
  • Resolve any issues or denials related to pre-authorizations.
  • Educate patients on insurance coverage and financial responsibilities.
  • Ensure compliance with all relevant regulations and policies related to insurance authorization processes.

Minimum Qualifications:

  • Two years of experience in the healthcare field is required with previous call center experience is preferred.
  • Minimum one year in Prior Auth and or Insurance verification

Preferred: Experience in Spinal Cord, Kyphoplasty highly preferred

Essential Functions

  • 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.

Qualifications and Skills:

  • High school diploma or equivalent; additional education in healthcare administration or related field preferred.
  • Proven experience in medical billing, insurance verification, or procedure authorization within a healthcare setting.
  • Strong understanding of medical terminology and insurance procedures.
  • Excellent communication skills, both verbal and written.
  • Ability to work independently and collaboratively in a fast-paced environment.
  • Detail-oriented with strong organizational and time management skills.
  • Proficient computer skills, including knowledge of electronic health record (EHR) systems and insurance portals.
  • Familiarity with CPT and ICD-10 coding preferred.

Working Conditions:

  • This position is typically based in an office environment within a healthcare facility.
  • Regular hours with occasional overtime may be required based on workload and deadlines.
  • Interaction with patients, healthcare providers, and insurance representatives is common.

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