Specialty Scheduling / Prior Authorization Representative

About Minnesota Epilepsy Group Minnesota Epilepsy Group (MEG) is the largest and most comprehensive adult and pediatric epilepsy program in the Midwest. As a regional referral facility, MEG is a recognized leader in the diagnosis and treatment of epilepsy and other seizure-related conditions, serving patients from infancy through adulthood. MEG is a nationally recognized,state-of-the-artLevel 4 Epilepsy Center committed to improving each patient’squality of life and maximizing seizure control through comprehensive, specialized care. Position Summary The Specialty Scheduling / Prior Authorization Representative is responsible for coordinating complex inpatient and outpatient procedures, diagnostic testing, surgical services, and admissions for both adult and pediatric patients. This position works closely with insurance companies to obtain required certifications, prior authorizations, referrals, extensions of stay, and other necessary approvals. The Representative also assists with insurance appeals and prepares supporting documentation and correspondence related to medical necessity, authorization requests, and insurance determinations. This role collaborates closely with physicians, clinical staff, the Business Office, front desk staff, hospitals, patients, families, and caregivers to ensure services are coordinated efficiently and patients receive a high level of customer service and support throughout the care process. Major Duties and Responsibilities Coordinate surgical procedures, diagnostic testing, inpatient stays, outpatient procedures, and related admissions for adult and pediatric patients. Obtain required certifications, prior authorizations, referrals, and insurance approvals for surgical procedures, diagnostic testing, inpatient admissions, outpatient services, and other specialty services. Monitor authorizations and communicate with insurance companies regarding authorization status, additional clinical information, extensions of stay, changes in treatment plans, and other requirements. Work collaboratively with physicians, clinical staff, affiliate hospitals, and internal and external departments to coordinate and schedule surgical admissions, diagnostic testing, inpatient admissions, and other patient services. Participate in weekly surgical conferences and assist with coordinating services and completing follow-up items identified during conference. Prepare correspondence and supporting documentation on behalf of patients, including letters of medical necessity, appeal letters, authorization requests, and other insurance-related communications. Review medical records and chart documentation to identify changes in patient status, treatment plans, and clinical response, and communicate relevant information to insurance companies as necessary to support authorization requests and continued services. Document and maintain accurate, complete, and timely information related to admissions, surgical services, authorizations, and other assigned responsibilities. Communicate with patients, families, and caregivers regarding scheduling, admissions, authorizations, and other aspects of the care process. Provide epilepsy-related education and instructions, as appropriate and within the scope of the position. Identify problems, barriers, and opportunities for improvement and recommend solutions that support efficient operations, compliance with applicable standards, and an improved patient experience. Develop and maintain positive, professional working relationships with MEG employees, departments, physicians, affiliate organizations, patients, families, caregivers, and external partners. Perform other duties and responsibilities as assigned by management. Position Requirements Two to three years of healthcare scheduling experience preferred. Strong knowledge of health insurance requirements, including prior authorizations, referrals, medical necessity requirements, denials, and appeals processes preferred. Strong understanding of medical terminology and experience working in a healthcare environment. Experience coordinating complex procedures, diagnostic testing, hospital admissions, surgical services, or other specialty healthcare services preferred. Experience working with insurance companies, healthcare payer portals, or electronic authorization systems preferred. Essential Functions and Skills Ability to communicate effectively in English, both verbally and in writing. Strong attention to detail, organization, time management, and customer service skills. Ability to communicate effectively and professionally with individuals at all levels of the organization, including patients, families, caregivers, physicians, referring providers, hospital staff, and insurance representatives. Strong skills utilizing written, telephonic, and online systems to obtain, verify, document, and communicate referral and prior authorization information with clinics, insurance companies, and affiliate hospitals. Ability to work independently, prioritize multiple responsibilities, exercise sound judgment, and appropriately elevate patient care or operational concerns when necessary. Proficiency with Microsoft Word, Excel, Outlook, insurance‑specific websites and portals, and other software or systems necessary to perform the responsibilities of the position. Ability to remain calm, professional, organized, and solution‑oriented in stressful or fast‑paced situations. Ability to establish and maintain effective working relationships with a diverse range of individuals, from patients and families to physicians and other healthcare professionals. Ability to maintain patient confidentiality and privacy in accordance with MEG policies and applicable HIPAA regulations. Ability to follow all security and confidentiality requirements as defined by MEG policies and applicable HIPAA regulations. Ability to bend, stoop, twist, and lean multiple times throughout the workday. Position Details Employment Status: Full-Time Schedule: Monday through Friday Work Location: Primarily onsite; remote work may be considered in the future based on business needs, job performance, and operational requirements. Additional Information This job description is not intended to be all-inclusive. Duties, responsibilities, and requirements may be modified, expanded, or assigned by management as necessary to meet the needs of the organization. Minnesota Epilepsy Group, P.A. is an Equal Opportunity Employer. #J-18808-Ljbffr The Minnesota Epilepsy Group