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Surgical Authorization Coordinator

2 months ago

Atlanta, Georgia, United States PEDIATRIC EAR NOSE & THROAT OF ATLANTA PC Full time
Job Description

PEDIATRIC EAR NOSE & THROAT OF ATLANTA PC is seeking a skilled and detail-oriented individual to join our team as a Surgery Prior Authorization Specialist.

Job Summary:

The Surgery Prior Authorization Specialist is responsible for managing the prior authorization process for upcoming surgical cases. This role involves ensuring that all authorizations are obtained accurately and in a timely manner, while coordinating closely with physicians, surgical centers, and insurance companies.

Key Responsibilities:

  • Monitor and manage authorizations for upcoming surgical cases, ensuring timely and accurate approval.
  • Verify patient demographic information and insurance eligibility, including coordination of benefits.
  • Complete surgical cost analysis forms and provide cost estimates for patient collections prior to surgery.
  • Verify insurance benefits for all surgical procedures.
  • Document authorizations and update patient records with authorization progress.
  • Enter authorization information into the case management system.
  • Communicate effectively with physicians, patients, coworkers, hospitals, and surgical centers.
  • Provide ongoing training to staff on new processes to ensure timely surgical case confirmations.
  • Assist surgery schedulers with urgent (STAT) authorizations.
  • Maintain confidentiality of health records and patient information in compliance with HIPAA guidelines.
  • Identify workflow improvement opportunities and work with the department manager to resolve any complaints professionally and promptly.
  • Attend department meetings as required.

Requirements:

  • Minimum one year of experience in prior authorization and insurance verification.
  • Prior experience in Ears, Nose & Throat (ENT) is highly preferred.
  • Familiarity with EMR systems: EPIC and/or ModMed, is highly preferred.
  • Familiarity with insurance processes and authorizations.