Operations Authorization Specialist

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Rothman Orthopaedics is looking to hire an Operations Authorization Specialist based in our Northeast Philadelphia office!

Schedule: Monday to Friday 8 AM to 4:30 PM

Location: First 90 days onsite full time for training in our Northeast Philadelphia office. Once training is complete, the position will become fully remote and/or hybrid.

The Position:

The Operations Authorization Specialist ensures accurate, efficient processing and professional, customer-focused interaction with all stakeholders including patients, physicians and clinical teams, insurance companies, and adjusters.

• Competency: Administrative Excellence: Process all incoming requests for pre-certification and authorization for imaging studies (MRI, CT scan, ultrasound, arthrograms, nuclear medicine, bone scan, DEXA, etc.), pain procedures and injections, and same day/next day urgent surgical cases. Review all requests for required information necessary for approvals, such as benefit and insurance information, demographics, and contact numbers. For out of network requests, obtain benefits, deductibles, and applicable out of network expenses and communicate promptly and accurately with patients to allow time to arrange for payment. Ensure comprehensive but succinct notes are kept in the patient chart throughout the process, such that anyone who needed an update on the status would be able to provide information to the requesting party. Share authorization information via phone, fax, or other modalities to insurance companies, adjusters, medical review departments, and patients as needed. Practice good time management by prioritizing authorization in date order and by time requirements of the payer. Notify leadership when payer terminations are encountered so patient accounts may be updated and notify patients. Send required letters of medical necessity to clinical team in a timely manner.
• Competency: Customer Focus: Exemplify the mission, vision, and values of the organization by engaging with all customers and patients with utmost respect and empathy. Provide timely, accurate, and considerate communication and updates to patients. Maintain professionalism in all encounters, including written documentation in patient charts.
• Competency: Authorization excellence: This role will obtain authorization for a variety of routine and urgent procedures and tests. Will require using judgement to prioritize based on date ordered, date of procedure, stat vs urgent vs routine, and payer requirements. At times may need to put all aside in order to focus on same day/next day needs. Will work in collaboration with centralized pre-certification department, surgical scheduling, clinical teams and physicians, office managers, and business office leadership. Ensures consistent accuracy in obtaining and documenting authorizations, timely communication to all stakeholders, with minimal denials following services rendered. Relying on clinical data in the chart, provide accurate information to the payer to make informed decisions about authorization for patient care.

Qualifications:

• High School diploma or GED required
• Medical assistant or clinical tech background helpful but not required.
• One year experience in a medical office setting helpful but not required.
• Medical office operations and medical terminology, understanding of insurance and benefits
• Computer skills including, but not limited to, MS Office

Our Commitment to Employees:

Come work at Rothman Orthopaedics! Our employees are our single greatest asset, as such, we strive to provide a professional, nurturing environment where every member of our team can make a meaningful difference in the lives of others. This commitment to our employees has earned us the distinction as a Top Workplace in Philadelphia by the Philadelphia Inquirer year after year. Our employees enjoy competitive pay, comprehensive health and dental benefits, tuition reimbursement, paid time off, and retirement savings plans.

Rothman Orthopaedics is an Equal Opportunity employer committed to providing opportunities to all qualified applicants without regards to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. We value developing an inclusive and equitable environment that strengthens our organization and allows us to better attract and retain a diverse workforce that is representative of our patients and our community. We model our values by creating and enacting practices that encourage participation from all backgrounds, perspectives, and experiences.

As a condition of employment at Rothman Orthopaedics, it is required you receive the COVID-19 vaccination. Rothman Orthopaedics is an Equal Opportunity Employer and requests for reasonable accommodations will be considered.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• prior authorizations: 1 year (Preferred)

Work Location: Hybrid remote in Philadelphia, PA 19114