Prior Authorizations Specialist - General Surgery
About the role
Located at 115 Technology Dr, Trumbull (10432). Schedule: Monday‑Friday, 8:00 am – 4:30 pm. Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. Hartford HealthCare Medical Group is one of the largest medical practices in New England with multiple locations throughout Connecticut and Rhode Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group enjoys an excellent reputation with patients and the medical community, offering primary care, urgent care and more than 30 different specialties.
Responsibilities
- Perform all clerical duties required to obtain insurance prior authorizations for in‑office procedures and surgical services in a timely manner.
- Create, maintain and manage resources, including insurance portal access.
- Maintain consistent documentation in EPIC to support obtained insurance authorizations.
- Communicate changes in payer and federal regulatory guidelines to manager, providers and other clinical departments as applicable.
- Monitor and review the prior authorization work queue daily to verify patient insurance information and interpret pre‑authorization requirements for scheduled procedures.
- Contact insurance companies via telephone and/or portals to obtain prior authorizations, providing necessary clinical documentation to ensure authorization before the scheduled procedure date.
- Document in EPIC prior authorization details such as number of treatments authorized, length of authorized treatment, authorization numbers, and insurance company contact or call reference number.
- Immediately notify the provider when a procedure or surgery is denied by the insurance company.
- Assist in setting up peer‑to‑peer reviews.
- Collaborate with pharmacy regarding preferred drugs on the specific insurance plan and notify providers of alternatives.
- Maintain a log of missed prior authorizations and assist the manager with timely retro authorizations or appeals to recoup revenue.
- Collaborate with hospital departments on billing, information management, policies, procedures and general operations related to prior authorizations.
- When time permits, help with front‑desk duties: managing incoming phone calls, baskets, answering phones, transcribing orders and referrals.
- Monitor referral work queue, register arriving patients, answer incoming calls, assist with surgical scheduling, and perform other assigned duties as needed.
Qualifications
- High School Graduate/Diploma preferred.
- At least one year of experience working with insurances and prior authorizations (preferred).
- Experience and knowledge of insurances and prior authorizations.
- Ability to communicate effectively and professionally with physicians, clinical and administrative staff, managers, patients and insurance companies.
- Self‑motivated with the ability to work independently and as part of a team.
- Excellent telephone, computer, organization and customer service skills.