Surgical Authorization Specialist
Posted 6ds ago
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Job Description
Surgical authorization specialist coordinating insurance approvals, eligibility, benefits, and cost estimates for HOPCo’s Phoenix-based orthopedic care operations. Supporting schedulers, patients, providers, and clinical staff.
Responsibilities:
- Monitor authorizations for upcoming surgical cases on physicians’ calendars, ensuring timely and accurate authorization
- Verify patient demographics, insurance eligibility, and coordination of benefits
- Complete surgical cost analysis forms and document required cost estimates for collection before services
- Verify benefits for all surgical procedures
- Document authorization progress in patient charts and enter authorization information into case management
- Provide ongoing staff training and education on new processes
- Work with the department manager to respond to and reduce complaints
- Assist surgery schedulers with STAT authorizations
- Maintain confidentiality of health records and member information in accordance with HIPAA
- Identify opportunities to improve daily workflow processes
- Attend department meetings as required
Requirements:
- High school diploma/GED or equivalent working knowledge is preferred
- Minimum of 2 years of experience in the healthcare field required
- Previous experience in referrals/authorizations, front office, and/or charge posting preferred
- Excellent organizational skills and strong customer service orientation
- Strong computer and data-entry background
- Working knowledge of eligibility, benefits verification, and prior authorizations for HMOs, PPOs, commercial payers, and other funding sources
- Knowledge of federal, state, and HIPAA privacy regulations
- Knowledge of computer applications
- Effective organization and billing requirements and authorization processes
- Proficiency with Microsoft Excel, Microsoft Word, and Outlook
- Ability to multitask in a fast-paced environment and maintain strong attention to detail
- Ability to understand patient demographic information and determine insurance eligibility
- Ability to work independently and analyze data
- Ability to communicate effectively and compassionately with patients, coworkers, management, and providers
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