Surgery Scheduler/Precertification Specialist

Job Summary

We are seeking a dedicated and detail-oriented Surgical Scheduler and Precertification Specialist to join our healthcare team. In this vital role, you will coordinate surgical procedures, manage insurance precertification processes, and ensure seamless communication between patients, providers, and insurance companies. Your expertise will help facilitate timely surgeries while maintaining compliance with healthcare policies and regulations. This position offers an opportunity to contribute to patient care through efficient scheduling and authorization management.

Responsibilities

• Schedule surgical procedures accurately by coordinating with physicians, patients, and operating room staff to ensure optimal timing and resource allocation.
• Obtain insurance prior authorizations by verifying patient coverage, submitting necessary documentation, and following up on approval statuses to prevent delays.
• Review medical records, including clinical notes, and procedure codes to support precertification requests.
• Maintain comprehensive documentation of all scheduling activities, insurance communications, and authorization statuses in electronic health records (EHR) systems.
• Verify patient insurance benefits and coverage details using healthcare management software while ensuring compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Collaborate with medical staff and insurance representatives to resolve authorization issues promptly, ensuring smooth patient flow for scheduled surgeries.
• Provide exceptional customer service by addressing patient inquiries professionally and maintaining confidentiality in accordance with clinical confidentiality policies.

Skills

• Strong knowledge of HIPAA regulations, medical terminology, and clinical confidentiality policies to protect patient information.
• Proficiency in CPT coding, ICD coding (ICD-9 and ICD-10), DRG, medical billing, and insurance verification processes.
• Experience with EMR/EHR systems for managing electronic health records efficiently.
• Familiarity with managed care plans, health insurance policies, prior authorization procedures, and health insurance policy nuances.
• Excellent organizational skills with the ability to multitask in a hospital environment.
• Proficient in Microsoft Office applications for documentation and communication purposes.
• Prior experience in a large multi-specialty surgical medical office setting, hospital, or ASC is preferred; familiarity with medical records management is essential.
• Outstanding customer service skills combined with a proactive approach to problem-solving in healthcare administration.

Join our team to make a meaningful difference by streamlining surgical scheduling processes and ensuring patients receive the care they need without unnecessary delays!