Revenue Cycle Specialist II
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Job Description
Surgery authorization specialist managing insurance verification, payer approvals, and patient costs. Supporting healthcare revenue cycle operations through accurate documentation and denial resolution.
Responsibilities:
- Verify insurance eligibility and benefits prior to scheduled surgical services
- Review, submit, and track surgical authorization and pre-certification requests
- Communicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations, and referrals
- Interpret payer medical policies and clinical guidelines to confirm medical necessity
- Calculate and communicate estimated patient financial responsibility prior to surgery
- Monitor authorization requests through final determination and follow up on pending cases
- Collaborate with clinical staff, surgery schedulers, and revenue cycle teams to resolve authorization issues or denials
- Support escalation cases, including coordination of peer-to-peer reviews when required
- Document authorization activity and payer communication in the EMR/EPM system
- Respond to patient inquiries regarding insurance benefits, authorizations, and surgery-related costs
- Maintain compliance with payer requirements, healthcare regulations, and internal workflows
- Manage a high volume of work while maintaining accuracy, attention to detail, and customer service
- Perform other related duties as assigned
Requirements:
- High School Diploma or equivalent
- Minimum of 3 years of recent experience in surgical authorization, insurance verification, or healthcare revenue cycle
- Proficiency in CPT, ICD-10, and HCPCS coding, including modifiers
- Strong knowledge of insurance authorization processes and payer websites/portals
- Ability to read and interpret medical records and Explanation of Benefits (EOBs)
- Strong organizational skills with the ability to manage multiple priorities and deadlines
- Excellent verbal and written communication skills
- Proficiency with Microsoft Office and electronic medical record (EMR/EPM) systems
- Ability to work independently and collaboratively in a fast-paced, high-pressure environment
- Ability to sit for extended periods, move throughout the office as needed, and perform light lifting
- Manual dexterity required for frequent computer and phone use
- Attention to detail and accuracy
- Good leadership, interpersonal, and communication skills
Benefits:
- Fully remote work arrangement
- Monday–Friday daytime schedule
- Occasional after-hours meetings may be required
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