Authorization Specialist

5 days ago


Wilmington, North Carolina, United States EmergeOrtho Full time
About the Role

EmergeOrtho is a leading provider of innovative, quality-focused comprehensive musculoskeletal care. We are seeking a highly skilled Authorization Specialist to join our team.

Key Responsibilities
  • Procure effective surgical authorization information for patient surgical services from insurance carriers.
  • Utilize online services from insurance companies to obtain surgical authorizations and gather information regarding patients' coverage for services.
  • Process all items for review in the practice management system and assign to the department and/or third-party software.
  • Handle all calls and/or written inquiries regarding appointment service surgical authorizations through resolution.
  • Research, correct, and re-file any denied or rejected surgical authorization to maximize reimbursement.
  • Ensure surgical authorizations are up-to-date, entering surgical authorizations into the Electronic Health Record (EHR), scanning, and linking surgical authorizations to the patient's chart.
  • Coordinate with the surgery department, specialists, and ancillary departments for scheduling and authorization purposes.
  • Contact patient insurance providers to obtain authorization and confirm eligibility status for the surgery and verify patient insurance coverage, including deductibles and out-of-pocket maximums.
  • Calculate patient payment amounts to be paid to EmergeOrtho prior to surgery.
  • Document all information obtained in the practice management system to relay to all staff and/or third-party software.
  • Report rules, changes, and other information affecting surgical authorizations to the Medical Records Supervisor.
  • Print reports from the practice management system to facilitate surgical authorization for appointment services for previously scheduled patients and patients added on.
  • Participate in educational and training opportunities to maintain current knowledge of payment policies.
Requirements
  • High school diploma or equivalent required.
  • A minimum of 3 to 5 years of experience in a medical office environment preferred.
Qualifications and Experience
  • Prior medical assistant experience.
  • Strong customer service skills.
  • Ability to positively interact with providers, staff, patients, and their family members.
  • Ability to work in a fast-paced environment.
  • Ability to prioritize and handle multiple tasks and demands.
  • Sound interpersonal skills.
  • Strong organizational skills.
  • Strong computer skills.


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