Surgical Authorization Specialist- Remote

ESSENTIAL FUNCTIONS

• Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.

· 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 surgical procedures.

· Document 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.

· Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.

· Assists in identifying opportunities for improvement within the daily workflow process.

· Attends department meetings as required.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• A minimum of 2 years of experience in the 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 a strong background in computers and data entry.

KNOWLEDGE

• 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.

SKILLS

• Skill in effective organization and billing requirements and authorization processes.

· Skill in using computer programs and applications including Microsoft Excel, Microsoft Word, and Outlook

· Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multi-task in a fast-paced environment. Must be detailed oriented with strong organizational skills.

· Ability to understand patient demographic information and determine insurance eligibility.

· Ability to work independently and demonstrate the ability to analyze data.

· Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.

Originally posted on Himalayas