Authorization Specialist

2 weeks ago

San Antonio, United States TSAOG Orthopaedics and Spine Full time

Get to know us:

TSAOG Orthopaedics and Spine is a large multi-specialty physician group. We have been here since 1947 and were not going anywhere. We take a big part in Community outreach with our Light Charity program. If you are looking for a team that enjoys Laughing, is Family orientated, and has the work hard play hard mentality, then this company is for you. We value Respect, Communication, Accountability, Dependability and Compassion. A place where you can rely on great Teamwork and Integrity. We are a place that is true to its values. If this is what you are looking for then look no further.

Summary of position:

We are looking for a sharp, ambitious, and enthusiastic Authorization Specialist to join our team. The successful candidate is someone that is passionate about working in a care team model with a personal responsibility of providing care for our orthopaedics patients and clinical support to the team. The right candidate will be able to provide an exceptional patient care experience that promotes healing and recovery, and having an attention to detail mindset while being caring and compassionate.

If you're a people person looking to join an amazing company in the world of Orthopaedics, this is the place for you

Current positions available for Authorization Specialist: Surgery Authorization Specialist and Imaging Authorization Specialist

What Youll Do:

Request precertification for surgical procedures via insurance portals and/or contacting insurance company to verify requirements.
Provide relevant clinical information to insurance company precertification department to obtain authorization for procedures.
Obtains authorizations from primary care physicians as insurance dictates.
Verify eligibility of patients insurance plan
Ensures patients have been cleared for specialty service office visits if insurance requires.
Resolves pre-certification, registration, and case-related concerns prior to a patient's procedure.
Respond to phone calls/messaging from internal doctor teams, check in/check out staff, or primary care physician offices and respond accordingly.
Relays pertinent messages from hospitals and directs team to reschedule surgical procedures at facility where benefits are accepted.
Effectively review orders to ensure that surgical procedures have been through pre-authorization process and review statuses.
Obtain appropriate next steps for adverse determinations and provide information to doctor teams.
Maintain knowledge and education to be effective and productive on prior authorization requirements.
Data enters pre-authorization deductibles, co-insurance, out-of-pocket and related information into patient demographic record.
May be required to assist other areas in referrals/authorizations when staffing is needed.
May explain benefits information to patients who arrive to visit and may not understand their portion of the bill (co-pay, deductibles, etc.).
Participate in monthly and quarterly meetings within respective department and team to discuss policies, protocols, and best-practices.

Additional duties for Imaging Authorization Specialist:

Contact patients to resolve issues and/or update them on prior authorization status.
Review messages from check in/check out staff for any add-ons to verify benefits and pre-authorization requirements.
Assist with scheduling imaging appointments as needed.
Screen patient calls efficiently ensuring accurate registration and appointment scheduling into database.
Respond to patients questions and needs by editing, canceling, and re-scheduling appointments as necessary according to Company protocols.

What Youll Need:

Must have a High School Diploma or equivalent.
Knowledge of health insurance concepts (i.e., HMO, PPO, etc.). Experience in a healthcare environment a plus. Knowledge of referrals and authorizations process.
Proficient computer skills. Exceptional customer service skills. Proficient and accurate data entry skills. Proficient with Microsoft programs (Excel, Word, etc.)
Ability to multi-task, prioritize work and make sound judgements. Ability to remain patient during long periods of telephonic hold times..
Prolonged sitting. Repetitive motion (data entry), and phone contact.
Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company.

#BackOffice4

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