Preauthorization Specialist

Job Description

Job Description

Benefits:

• Health insurance
• Paid time off
• Profit sharing
• Vision insurance
• 401(k)
• Company parties
• Dental insurance

This position is responsible for ensuring medical criteria is met and obtaining timely authorization from insurance carriers to optimize revenue cash flow.  Coordinates with schedulers prior to any procedures to obtain proper authorizations (i.e durable medical equipment, injections, surgeries, etc.). Maintains a working knowledge of our financial system and knowledge of insurance requirements.  Responsible for collecting, reviewing, discussing and documenting demographic, insurance and financial information with patients and payers.  Collect surgery deposit payments prior to surgery. Makes independent decisions that require individual and/or team analysis, reasoning, and problem solving.  Accurately documents interactions and interprets interactions documented by others. Processes accounts and incoming payments in compliance with financial policies and procedures. Provides options for the uninsured or indigent patients (Credit card applications, County Assistance, payment arrangements, etc.) Performs other related duties as assigned. 

Essential Job Functions:

• Coordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage while ensuring meets medical criteria.
• Able to triage incoming calls and requests from provider groups/patient for authorization of services, questions, status updates
• Collect surgery deposits
• Ensure professional communication with patients, clinic personnel, and outside vendors whether over the phone, via email or other written documentation and respond to all inquiries
• Maintain a working knowledge of health care plan requirements and health plan networks
• Verify and document insurance information as defined by current business practices
• Accurately post all payments received from patients, attorney offices and/or insurance companies

Minimum Qualifications:

1.       High school diploma or equivalent.
2.       Excellent communication and interpersonal skills
3.       Excellent knowledge of billing procedures
4.       Requires confidence in speaking to patients and asking for surgery deposits prior to surgery
4.       Previous experience in healthcare in relation to obtaining insurance authorizations
5.       Insurance knowledge in commercial, work comp, and government payers required
6.      CPT and ICD10 knowledge preferred
7.       Efficient in the use of standard office equipment, data entry, typing, 10-key skills, and alpha/numerical filing.

Essential Functions (Physical):

• Regular and predictable attendance is an essential job function.
• Majority of the shift is spent sitting.
• Frequent reaching, stooping and twisting when filing, accessing records and answering telephone
• Ability to lift up to 25 pounds.
• Read a variety of printed and handwritten materials, computerized reports, manuals, and correspondence.
• Communicates with patients, physicians, families and co-workers in person and on the telephone.
• Comply with company policies, procedures, practices and business ethics guidelines.
• Complete job required training.
• Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
• Work in the office during business hours
• Work at an efficient and productive pace, handle interruptions appropriately and meet deadlines
• Communicate and interact in a respectful and professional manner
• Prioritize workload while being flexible to meet the expectations of the daily operations
• Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions
• Understand and execute a variety of instructions
• Work independently with minimal supervision

Work Environment:

• Orthopedic Surgery & Sports Medicine operates in a professional office environment.  Days and hours of work are conducted Monday thru Friday 8:00 am to 5:00 pm.  
• This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
• Orthopedic Surgery & Sports Medicine has multiple locations and travel may be required.

  Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.  Duties, responsibilities and activities may change at any time with or without notice.