Pre-Authorization Specialist

We are seeking a highly motivated and detail-oriented individual to join our dynamic healthcare team as an Orthopaedic/Spine Preauthorization Specialist. In this position, you will play a crucial role in ensuring the smooth and efficient operation of our Preauthorization Department. You will be responsible for reviewing and processing preauthorization requests for Orthopaedic, Imaging, Surgery, Pain Management, and Spine procedures and treatments, working closely with healthcare providers, insurance companies, and patients to ensure timely approvals. 

Responsibilities:

• Review and evaluate preauthorization requests for orthopaedic procedures and treatments, ensuring completeness and accuracy of documentation.
• Verify patient insurance coverage and eligibility for requested services.
• Collaborate with healthcare providers to gather necessary medical records and supporting documentation.
• Communicate with insurance companies to obtain preauthorization approvals or address any additional information or documentation requirements.
• Maintain accurate and up-to-date records of preauthorization requests, approvals, and denials.
• Educate healthcare providers on preauthorization requirements and assist in resolving any preauthorization-related issues or concerns.
• Stay updated on insurance industry regulations, policies, and guidelines related to orthopaedic preauthorization.

Qualifications:

• Prior experience in orthopaedic preauthorization or medical insurance verification preferred.
• Strong knowledge of orthopaedic procedures, treatments, and medical terminology.
• Familiarity with insurance coding systems (e.g., CPT, ICD-10) and insurance claim processes.
• Excellent attention to detail and ability to analyze complex medical documentation.
• Strong communication skills, both written and verbal, with the ability to effectively interact with healthcare professionals, insurance companies, and patients.
• Proficient computer skills, including experience with electronic medical record (EMR) systems and preauthorization software.
• Ability to work independently and as part of a team, managing multiple priorities and meeting deadlines in a fast-paced environment.
• Commitment to maintaining patient confidentiality and adhering to HIPAA guidelines.