Surgical Prior Authorization Specialist

Position Summary

The Surgical Prior Authorization Specialist is responsible for obtaining pre-authorizations from insurance carriers. Inputs the data accurately and timely into the EMR software. Review surgical schedules to determine which payors require prior authorization. Review clinical data matching it against specified medical terms and diagnoses or procedure codes and follow established procedure for authorization requests.

Role Overview/ Key Responsibilities

Ensure accuracy of patient data, demographic and insurance information. Communicate with the Surgical Scheduling Coordinator that prior authorization has been obtained and the patient is ready to be scheduled. Communicate with patients, providers, and coordinators to inform if their insurance has denied the authorization request. Work directly with patients to have them assist with obtaining prior authorization from their insurance carrier when needed. Follow-up on all denials. Document and track all communication attempts with insurance providers. The position will also perform light administrative duties, and any other tasks as assigned.

Required Qualifications

• Minimum one-year experience with prior authorization experience in healthcare.

• Knowledgeable in medical terminology, CPT codes, ICD-10, NCCI edits and LCD policies.

• Computer skills: web browsing, Excel, EMR software and use of insurance portals.

• Excellent verbal and written communication skills.

• Understanding of authorization procedure workflow.

• Understanding of HIPPA regulations.

• Respect for patient confidentiality.Preferred Skills/Qualifications

• Ability to analyze data to provide appropriate information to insurance companies.

• Ability to respond to questions in a tactful and professional manner.

• Ability to multitask, prioritize tasks, and work efficiently.

• Efficiency and attention to detail.

Physical & Work Environment

Administrative office (in office only)