Authorization Specialist Orthopedics & Spine

About the role

Reviews, analyzes, and interprets complex medical information, applying specific knowledge of coding requirements and conventions to correctly classify, code and abstract health information. Works collaboratively with the medical staff and other clinical services staff. This role focuses on monitoring expirations of referrals, verifying insurance updates prior to procedure, and supporting authorization and denial processes.

Responsibilities

• Reviews the record for information regarding diagnoses and procedures performed.
• Uses established coding/classification systems to accurately code diagnoses, procedures and evaluation and management, in compliance with hospital policy/procedures and industry standards.
• Abstracting/Data entry.
• Works closely with referrals, authorizations, and denial teams.
• Interacts with medical and clinical services staff in a positive and professional manner.
• Educates staff as needed.
• Completes state-specific registry abstracts as required.
• Meets established quality/productivity standards.
• Maintains certification/credentialing.
• Adheres to established hospital policy and procedure related to job functions.
• Maintains confidentiality related to patients, staff, and visitors.

Requirements

• Certified Coding Specialist, Accredited Record Technician (or eligible), Registered Record Administrator (or eligible) or Licensed Practical Nurse (LPN) with a minimum of 5 years’ experience in an appropriate health care setting.
• Ideally, has a background in referrals, denials, and/or authorization processes.
• Working knowledge of ICD-9-CM, CPT & E & M coding conventions as applicable.
• Participates in orientation and continuing education.
• Updates and maintains knowledge and skills related to specific areas of expertise.

Skills

• Knowledge of office equipment, PC/CRT skills.
• Close visual/concentration efforts required (due to potential to review records continuously).
• Excellent communication skills, both oral and written, as well as good interpersonal skills required.
• Ability to work with confidential material in a responsible manner.
• Customer service orientated.
• Strong communication skills with both colleagues and patients.

Pay

Pay range: $19.50‑$25.15 per hour.