Surgical Authorization Specialist
RemoteUnited States
Job Summary
Monitor upcoming surgical authorizations on physician calendars to ensure timely and accurate case processing. Verify patient demographics, insurance eligibility, and coordination of benefits while updating charts and entering data into case management systems. Complete surgical cost analysis forms to document estimations prior to services and document authorization progress. Communicate effectively with physicians, patients, and internal/external customers to resolve inquiries and reduce complaints. Assist surgery schedulers with STAT authorizations and participate in staff training for new processes. Ensure strict confidentiality of health records in compliance with HIPAA guidelines and assist in identifying workflow improvements.
Required Qualifications
- A minimum of 2 years of experience in the healthcare field
- Excellent organizational skills
- Strong customer service orientation
- Strong background in computers and data entry
- Working knowledge of eligibility
- Working knowledge of verification of benefits
- Working knowledge of prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources
- Must be able to communicate effectively with physicians, patients, and co-workers
- Capable of establishing good working relationships with both internal and external customers
- Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines
Desired Qualifications
- Previous experience in referrals/authorizations, front office, and/or charge posting
- Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases
- Assist surgery schedulers with STAT authorizations
- Assists in identifying opportunities for improvement within the daily workflow process
- Attends department meetings as required
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