Surgical Authorization Specialist- Remote

RemoteRemoteFull TimePosted 28 days agoHidden Gem · Himalayas

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Required skills

surgical cases
authorizations
physician calendars
patient demographic information
insurance eligibility
coordination of benefits
surgical cost analysis
case management
confidentiality
HIPAA

Nice to have

referrals
front office
charge posting
Process Improvement

Role summary

The Surgical Authorization Specialist is responsible for monitoring and obtaining timely and accurate authorizations for upcoming surgical cases. This remote role involves verifying patient demographics and insurance eligibility, coordinating benefits, completing surgical cost analyses, and documenting authorization progress. The specialist will also communicate with physicians, patients, and colleagues, assist with STAT authorizations, ensure HIPAA compliance, and identify workflow improvements. A high school diploma/GED, 2 years of healthcare experience, and strong computer and customer service skills are required.

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.

Originally posted on Himalayas

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