Surgical Authorization Specialist- Remote

Essential Functions

• Maintains authorizations for upcoming surgical cases on the physician’s calendars.
• Verifies patient demographic information and insurance eligibility, including coordination of benefits.
• Accurately completes surgical cost analysis forms, documenting required surgical cost estimation for collection.
• Verifies benefits on all surgical procedures.
• Documents authorizations and progress of authorizations in the patient’s chart.
• Enters authorization information within case management systems.
• Communicates effectively with physicians, patients, and colleagues.
• Participates in training and education of staff regarding new processes.
• Responds to and reduces complaints professionally and timely.
• 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

  • 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.
  • Skilled in using computer programs and applications.
  • Establishes good working relationships with both internal and external customers.

  Abilities

  • Multi-tasks in a fast-paced environment.
  • Detail-oriented with strong organizational skills.
  • Understands patient demographic information and determines insurance eligibility.
  • Works independently and demonstrates the ability to analyze data.
  • Communicates effectively and compassionately with patients, co-workers, management, and providers.