Surgical Authorization Specialist

4 weeks ago

Austin, Texas, United States Advanced Pain Care Full time
Job Description

At Advanced Pain Care, we are seeking a highly skilled Surgical Authorization Specialist to join our team. As a key member of our Surgical Auth Department, you will be responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of outpatient and ancillary services.

Key Responsibilities:

  • Verify insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
  • Successfully work with payers via electronic/telephonic and/or fax communications.
  • Responsible for verification and investigation of pre-certification, predetermination, and referral requirements for services.
  • Determine medical necessity by reviewing the appropriate medical policies established for each insurance payer.
  • Collaborate with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
  • Communicate with patients, clinical navigators, financial counselors, and others as necessary to facilitate authorization process.
  • Facilitate submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.
  • Appropriately prioritize workload to ensure the most urgent cases are handled in a timely manner. Complete accurate documentation in electronic medical record.
  • Complete notification to all payers via electronic/fax/telephonic means within 24 business hours of service to ensure compliance with Managed Care contractual requirements.
  • Follow departmental policies and procedures when necessary authorization is not obtained prior to service date.
  • Answer provider, staff, and patient questions surrounding insurance authorization requirements.
  • Operate standard office equipment (e.g. copier, personal computer, fax, etc.).
  • Have regular and predictable attendance.
  • Adhere to Advanced Pain Care's Policies and procedures.
  • Perform other duties as assigned.

Requirements:

  • Minimum of three years' experience in billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO's and PPO's required.
  • Clear and effective communication.
  • Exceptional customer relations skills required.
  • Knowledge of billing terminology including CPT codes and ICD-10 codes.
  • Knowledge of online insurance portals.
  • Excellent typing and computer skills.
  • Effectively manage day by organizing and prioritizing.
  • Apply tactful principles and practices of dealing with the public.
  • Practice safety habits.
  • Protect patient information and maintain confidentiality.

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