Surgical Authorization Specialist

Job Description

Job Description

ESSENTIAL FUNCTIONS
• Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
• Accurately completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
• Verifies benefits on all surgical procedures.
• Document authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
• Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
• Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
• Work with department manager to respond to and reduce complaints timely and professionally.
• Assist surgery schedulers with STAT authorizations.
• Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
• Assists in identifying opportunities for improvement within the daily workflow process.
• Attends department meetings as required.

EDUCATION
• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE
• A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
• Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.

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.

SKILLS
• Skill in effective organization and billing requirements and authorization processes.
• Skill in using computer programs and applications including Microsoft Excel, Microsoft Word, and Outlook
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES
• Ability to multi-task in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently and demonstrate the ability to analyze data.
• Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.

ENVIRONMENTAL WORKING CONDITIONS
• Normal office environment.

PHYSICAL/MENTAL DEMANDS
• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching are required.
• Manual dexterity using a calculator and computer keyboard