Surgical Authorization Specialist

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.