Surgical Authorization Specialist- Remote

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ESSENTIAL FUNCTIONS
  • Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
  • Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
  • Accurately completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
  • Verifies benefits on all surgical procedures.
  • Document authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
  • Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
  • Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
  • Work with department manager to respond to and reduce complaints timely and professionally.
  • Assist surgery schedulers with STAT authorizations.
  • Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
  • Assists in identifying opportunities for improvement within the daily workflow process.
  • Attends department meetings as required.
EDUCATION
  • High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
  • A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
  • Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
KNOWLEDGE
  • Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
  • Federal, state, and HIPAA privacy regulations.
  • Knowledge of computer applications.
SKILLS
  • Skill in effective organization and billing requirements and authorization processes.
  • Skill in using computer programs and applications including Microsoft Excel, Microsoft Word, and Outlook
  • Skill in establishing good working relationships with both internal and external customers.
ABILITIES
  • Ability to multi-task in a fast-paced environment. Must be detailed oriented with strong organizational skills.
  • Ability to understand patient demographic information and determine insurance eligibility.
  • Ability to work independently and demonstrate the ability to analyze data.
  • Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights ( notice from the Department of Labor.

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