Procedure Authorization Specialist- Remote

Essential Functions

• Maintains authorizations for upcoming surgical cases on the physician’s calendars.
• Verifies patient demographic information and insurance eligibility, coordinating benefits and updating necessary information.
• Accurately completes surgical cost analysis forms, documenting required cost estimations for claim submission.
• Verifies benefits on all surgical procedures and documents authorizations in the patient’s chart.
• Enters authorization information into case management systems.
• Communicates effectively with physicians, patients, and colleagues, building and maintaining positive relationships.
• Participates in training and education of staff regarding new processes to ensure timely confirmation of surgical cases.
• Collaborates with the department manager to address and resolve complaints promptly and professionally.
• Assists surgery schedulers with STAT authorizations.
• Ensures strict confidentiality of all health records and meets HIPAA guidelines.
• Identifies opportunities for workflow process improvement.
• Attends department meetings as required.

  Education

  High school diploma/GED or equivalent, with working knowledge preferred.

  Experience

  • A minimum of 2 years of experience in the healthcare field.
  • Previous experience in referrals/authorizations, front office, and/or charge posting is preferred.

  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, including Microsoft Excel, Microsoft Word, and Outlook.

  Skills

  • Effective organization and billing requirements and authorization processes.
  • Computer program and application proficiency, including Microsoft Excel, Microsoft Word, and Outlook.
  • Establishing good working relationships with both internal and external customers.

  Abilities

  • Multi-tasking in a fast-paced environment.
  • Detailed organizational skills and ability to analyze data.
  • Effective communication and compassionate interaction with patients, co-workers, management, and providers.

  Environmental Working Conditions

  Normal office environment.

  Physical/Mental Demands

  • Sitting and standing associated with a normal office environment.
  • Bending and stretching required.
  • Manual dexterity using a calculator and computer keyboard.

  Organizational Requirements

  HOPCo Mission, Vision, and Values must be read and signed.