Medical Authorization Specialist – Spine Surgery

Jobtailor; Deutschland; Remote; EUR 45.000 - 75.000; Vollzeit

Zusammenfassung

Jobtailor seeks an experienced Surgery Authorization Specialist to manage and process prior authorizations for orthopedic and spine procedures in a fast‑paced medical practice. You will navigate multiple insurance portals, verify requirements, track requests from submission to determination, prepare appeals, and ensure HIPAA compliant documentation while maintaining accurate records.

Strong communication with insurance carriers and clinical staff is essential, as is meticulous attention to

Qualifikationen

• Hands-on surgery authorization experience is required.
• Experience navigating multiple insurance portals is required.
• Strong understanding of prior authorization and insurance appeals.
• Experience communicating with insurance companies.

Aufgaben

• Manage and process surgery authorizations for orthopedic and spine procedures.
• Submit prior authorization requests through insurance portals and track from submission to determination.
• Prepare and submit insurance appeals with supporting documentation.
• Review codes, verify coverage, and ensure HIPAA-compliant documentation.
• Maintain records, reference numbers, and follow-up timelines.

Kenntnisse

Surgery Authorization

Insurance Portals

Prior Authorization

EHR/EMR Systems

HIPAA Compliance

English Communication

Ausbildung

NBI Clearance

Local Police Clearance

Tools

Epic

Cerner

Athena

Google Workspace

Microsoft Teams

Jobbeschreibung

• Manage and process surgery authorizations, particularly for orthopedic and spine procedures
• Review authorization requirements and verify insurance information
• Submit prior authorization requests through insurance portals
• Track authorization requests from submission through determination
• Ensure documentation and supporting information are complete and accurate
• Follow up on pending authorizations and outstanding requirements
• Maintain records of authorization status, reference numbers, correspondence, and next steps
• Assist with claims-related and insurance verification tasks
• Review denied or rejected authorization requests and identify denial reasons
• Prepare and submit insurance appeals
• Gather clinical documentation, notes, reports, and supporting records for appeals
• Track appeals and follow up within appropriate timelines
• Communicate updates and outstanding requirements to internal team members
• Navigate multiple insurance portals and research payer-specific requirements
• Make outbound calls to insurance companies regarding authorizations, appeals, claims, and documentation
• Document calls, reference numbers, decisions, and follow-up requirements
• Review procedure and insurance codes
• Reference clinical notes and reports through EHR/EMR systems
• Prepare reports, spreadsheets, and authorization documentation
• Maintain tracking spreadsheets and administrative records
• Handle information in accordance with HIPAA and confidentiality requirements
• Preferred: experience with orthopedic or spine surgery authorizations; familiarity with spine surgery procedure and insurance codes; understanding of workers' compensation; Epic, Cerner, Athena, Google Workspace/Google Sheets, Microsoft Teams, and previous support of a U.S.-based surgical, orthopedic, spine, or specialty medical practice

Requirements

• Previous hands‑on surgery authorization experience is required
• Previous experience navigating multiple insurance portals is required
• Strong understanding of the prior authorization and insurance appeals process is required
• Experience communicating directly with insurance companies is required
• Experience submitting and tracking authorization requests from start to completion
• Experience handling authorization denials and supporting the appeals process
• Ability to determine documentation and information required by different insurance companies
• Familiarity with insurance and medical procedure codes
• Ability to review clinical notes, reports, and supporting medical documentation
• Familiarity with EHR/EMR systems such as Epic, Cerner, Athena, or similar platforms
• Strong attention to detail and accuracy
• Ability to organize and track multiple authorization cases simultaneously
• Ability to prioritize tasks based on urgency and authorization timelines
• Strong documentation and follow‑up skills
• Professional communication skills when speaking with insurance representatives
• Ability to work independently and consistently follow cases through resolution
• Understanding of HIPAA, confidentiality, and accuracy when handling medical and insurance information
• Must speak and write English clearly and professionally
• Must have relevant work experience
• Must provide an NBI Clearance and/or Local Police Clearance before onboarding
• Must be available to attend video meetings with camera on when required
• Reliable laptop or desktop computer
• Stable high‑speed internet connection of at least 25 Mbps
• Noise‑canceling headset
• Working webcam
• Quiet and professional work environment
• Preferred: experience with orthopedic or spine surgery authorizations; familiarity with spine surgery procedure and insurance codes; understanding of workers' compensation; Epic, Cerner, Athena, Google Workspace/Google Sheets, Microsoft Teams, and previous support of a U.S.-based surgical, orthopedic, spine, or specialty medical practice

Core Competencies

Demonstrates expertise in managing surgery authorizations, particularly for orthopedic and spine procedures, with a strong understanding of the prior authorization and insurance appeals process. Proficient in navigating insurance portals, handling denials, and ensuring compliance with HIPAA regulations.

Highest-signal resume keywords

• Surgery Authorization Experience
• Insurance Portal Navigation
• Prior Authorization Process
• Insurance Appeals Process
• EHR/EMR Systems Familiarity

Hard Skills

• Authorization Request Submission
• Insurance Verification
• Documentation Review
• Claims Processing
• Procedure Code Familiarity
• Clinical Documentation Review
• Tracking and Reporting
• Denial Reason Identification
• Appeal Preparation
• HIPAA Compliance

Soft Skills

• Attention to Detail
• Professional Communication
• Organizational Skills
• Follow‑Up Skills
• Independent Work

Certifications & Qualifications

• NBI Clearance
• Local Police Clearance

Industry Keywords

• Orthopedic Surgery
• Spine Surgery
• Workers’ Compensation
• Insurance Codes
• Medical Procedure Codes

Tools & Technologies

• Epic
• Cerner
• Athena
• Google Workspace
• Microsoft Teams