Surgical Scheduler and Authorization Specialist

Description Surgical Scheduler & Authorization Specialist Prime Ortho | Tysons, VA | Full-Time | On-Site Compensation: $24–$30 per hour, based on experience About Prime Ortho Prime Ortho is a specialty orthopedic practice dedicated to providing exceptional patient care. Our physicians specialize in spine, sports medicine, and interventional pain management. We are seeking an experienced, highly organized Surgical Scheduler & Authorization Specialist to support four physicians and manage the scheduling and authorization process for surgical procedures and interventional pain injections. This is an excellent opportunity for a candidate who understands the complexities of orthopedic scheduling, is comfortable working directly with insurance companies, and can take ownership of cases from scheduling through authorization. This is a fully in-office position at our Tysons, Virginia location, Monday through Friday. Key Responsibilities Surgical & Procedure Coordination Independently manage surgical and procedure scheduling for four physicians specializing in spine, sports medicine, and interventional pain management. Coordinate surgical cases, outpatient procedures, and interventional pain injections with patients, physicians, surgical facilities, and clinical staff. Ensure procedure details, scheduling requirements, and supporting documentation are accurate and complete. Communicate preoperative instructions, scheduling updates, and outstanding requirements to patients. Proactively identify scheduling conflicts, missing documentation, and potential delays. Maintain organized, accurate records and ensure cases are appropriately tracked from scheduling through completion. Prior Authorizations & Insurance Management Independently manage prior authorization requests for surgical procedures, spine interventions, sports medicine procedures, and interventional pain injections. Verify insurance eligibility, benefits, authorization requirements, and applicable payer guidelines. Submit authorization requests with appropriate clinical documentation and follow up consistently on pending cases. Work directly with commercial insurance plans, Medicare Advantage plans, and other payers to resolve authorization issues. Monitor authorization deadlines and communicate potential delays to physicians and clinical staff. Track authorization approvals, denials, appeals, and outstanding requests to help prevent avoidable cancellations. Identify denial reasons and coordinate next steps with the appropriate physician and clinical team. Denials & Peer-to-Peer Coordination Coordinate peer-to-peer reviews between physicians and insurance company medical reviewers for denied authorizations. Schedule peer-to-peer appointments around physician availability and insurer deadlines. Gather denial letters, clinical documentation, and relevant authorization information before scheduled reviews. Communicate denial details and review outcomes to the appropriate team members. Track outcomes and ensure any additional documentation, appeals, or follow-up actions are completed promptly. Systems, Documentation & Workflow Management Maintain accurate scheduling and authorization records within the practice's electronic systems. Use scheduling and practice management tools to monitor case status, identify outstanding tasks, and maintain an organized workflow. Collaborate with physicians, clinical staff, and administrative team members to improve efficiency. Protect patient confidentiality and comply with HIPAA requirements. Required Qualifications Prior experience in surgical scheduling, preferably within an orthopedic, spine, sports medicine, pain management, or multispecialty practice. Strong hands-on experience obtaining prior authorizations for procedures. Experience managing insurance denials and coordinating peer-to-peer reviews. Ability to independently prioritize cases, manage deadlines, and follow up on outstanding authorizations. Excellent communication skills and the confidence to communicate professionally with insurance representatives, physicians, patients, and surgical facilities. Exceptional attention to detail, organization, and follow-through. Proficiency with electronic medical records and scheduling systems. Ability to work on-site five days per week at our Tysons office. Preferred Qualifications Athenahealth experience strongly preferred. Surgimate experience strongly preferred. Direct experience in orthopedic spine and interventional pain management authorization workflows. Familiarity with procedure-specific payer requirements and common authorization denial issues. Experience coordinating high-volume surgical schedules for multiple physicians. Experience with appeals, authorization tracking, and payer follow-up. Benefits Health insurance Dental insurance Vision insurance Paid time off (PTO) 401(k) with employer match Profit sharing The Ideal Candidate The ideal candidate is a self-starter who understands that successful surgical scheduling involves much more than finding an available date. They know how to navigate insurance requirements, anticipate authorization obstacles, coordinate peer-to-peer reviews, and keep cases moving forward. We are looking for someone who takes ownership, communicates proactively, works efficiently in a fast-paced medical practice, and requires minimal day-to-day oversight once trained. #J-18808-Ljbffr PRIME ORTHO LLC