Procedure Authorization Specialist
4 days ago
**Job Summary:**
We are seeking a highly organized and detail-oriented Procedure Authorization Specialist to join our team at the Center for Orthopedic and Research Excel. As a key member of our team, you will be responsible for ensuring that all necessary authorizations and verifications are completed prior to patient appointments.
Key Responsibilities:
- Obtain Benefit Verification and Necessary Authorizations: Verify patient demographic information and insurance eligibility, including coordination of benefits, to ensure accurate processing of claims.
- Use Online Verification Systems: Utilize web-based verification systems to review real-time eligibility responses and ensure accuracy of insurance eligibility.
- Create Appropriate Referrals: Generate referrals to attach to pending visits, ensuring seamless communication with internal and external stakeholders.
- Respond to Provider and Support Staff Questions: Address inquiries and concerns regarding patient prior authorizations, providing timely and accurate information.
Requirements:
- High School Diploma/GED: Equivalent working knowledge preferred.
- Experience in Healthcare: Minimum two to three years of experience in a healthcare environment, with prior authorization experience highly preferred.
- Communication Skills: Ability to effectively communicate with physicians, patients, and the public, establishing good working relationships with internal and external customers.
- Knowledge of Insurance Plans: In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.
Working Conditions:
- Normal Office Environment: Requires sitting and standing associated with a normal office environment.
- Manual Dexterity: Manual dexterity using a calculator and computer keyboard.
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