Authorization Specialist

Job Details

ESSENTIAL FUNCTIONS

• Monitors the authorizations of upcoming surgical cases on the physician's calendars ensuring authorizations for Viscosupplementation injections are obtained in a timely and accurate manor.
• 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 Visco injections.
• Documents 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.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred
• Minimum of 2 years' experience in 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 strong background with computers and data entry.
• 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.

About Premier Orthopaedics & Philadelphia Hand to Shoulder

Premier Orthopaedics and Philadelphia Hand to Shoulder Center (PHSC) are leading providers of comprehensive musculoskeletal care throughout Pennsylvania, New Jersey and Delaware.

Premier Orthopaedics delivers expert treatment for orthopedic injuries, joint disease, interventional spine care, regenerative medicine, and comprehensive physical therapy services, supported by more than 1200 providers across 50+ locations. Our facilities include state-of-the-art MRI centers, outpatient surgery centers, physical therapy clinics, and orthopedic urgent care centers to ensure timely access to high-quality, patient-focused care.

Philadelphia Hand to Shoulder Center (PHSC), a division of Premier Orthopaedics, has been nationally recognized for more than 50 years for its specialized care of the hand, wrist, elbow, arm, and shoulder. Our fellowship-trained surgeons and certified Hand and Occupational Therapists collaborate to provide seamless carefrom diagnosis and treatment to post-operative and rehabilitative recovery. With 20+ convenient locations across Pennsylvania and New Jersey, PHSC offers advanced, integrated care to restore function, mobility, and quality of life for patients with upper extremity conditions.

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.