Authorization Specialist

EmergeOrtho; Durham (NC); On-site; USD 25,000 - 36,000; Full time

Benefits offered by this job

401(k) Retirement plan

Health Insurance

Dental Insurance

Vision Insurance

Flexible spending account

Health savings account

Paid time off

Holiday Pay

Employee Assistance Program

Life Insurance

Short Term Disability

Long Term Disability

Pet Insurance

Milestone Bonus Program

Job summary

EmergeOrtho in Durham, NC seeks an Authorizations Specialist to obtain and apply all required authorizations, ensuring proper compensation for medical claims. You will verify insurance eligibility and act as a liaison among physicians, case managers, adjusters, and social workers.

The role requires solid experience in insurance billing, strong communication, and attention to detail. The position includes travel to multiple office locations as needed and upholds confidentiality across all patient

Qualifications

• High school diploma or equivalent.
• Experience in insurance billing and coding.
• Minimum two years of patient service experience in a healthcare setting.
• Ability to act with integrity, professionalism, and confidentiality.
• Experience using electronic medical records systems.
• Excellent communication and interpersonal skills.
• Excellent organizational skills and attention to detail.

Responsibilities

• Obtains orders from the physician.
• Log all orders in EMR for accurate tracking and scheduling.
• Eligibility, benefits, and authorization are obtained online or via telephone.
• Respond to clinical requests by providing accurate information. Follow up within 3 business days regarding authorization status.
• Schedule a peer-to-peer review with physician and insurance carrier if needed.
• Fax required documents to outside physician for treatment and appointment.
• Follow up on requests within 7-10 days to confirm information and appointment.
• Work diagnostic orders within 3-5 days; STAT orders immediately.
• Obtain surgical authorizations 10 days prior to surgery unless STAT.
• Maintain electronic log sheet for physical therapy patients; ensure confidentiality.
• Performs other duties as assigned by Manager; travel to office locations as needed.

Skills

Insurance billing

EMR systems

Communication skills

Interpersonal skills

Attention to detail

Education

High school diploma or equivalent

Tools

Electronic Medical Records (EMR)

Job description

The Authorizations Specialist is responsible for obtaining and applying all required authorizations, enabling the appropriate compensation for medical claims. Confirms patients’ insurance eligibility while obtaining authorization. The specialist acts as a liaison between referring physicians’ offices, case managers, adjusters, and social workers to obtain required authorizations.

Qualifications and Experience

• High school diploma or equivalent
• Previous experience in insurance billing and coding
• Minimum two years of patient service experience in a healthcare setting
• Ability to act with integrity, professionalism, and confidentiality
• Experience using electronic medical records systems
• Excellent communication and interpersonal skills
• Excellent organizational skills and attention to detail

Responsibilities include, but are not limited to the following

• Obtains orders from the physician
• Log all orders in EMR for accurate tracking and scheduling
• Eligibility, benefits, and authorization are obtained online or via telephone
• Respond to clinical requests by providing accurate information. Perform follow-up calls within 3 business days regarding the authorization status
• If a peer-to-peer review is needed prior to obtaining authorization, we will schedule with our physician and the insurance carrier’s Medical Director
• If the request is to have the patient be sent to an outside physician for treatment the office notes, patient demographics, and insurance card(s) are faxed to the outside physician’s office for an appointment
• Follow up on requests within 7-10 days to confirm accurate information has been received and confirm an appointment has been made
• Work diagnostic orders within 3-5 days of receipt. STAT orders are worked on immediately
• Obtain surgical authorizations 10 days prior to the surgery date unless the surgery is scheduled as a STAT
• Maintain the electronic log sheet, generated for physical therapy patients indicating patient demographics and therapy caps
• Maintains clinic and patient confidentiality
• Performs other duties as required and assigned by Manager, including schedule changes and travel to office locations as assigned

From the mountains to the coast, EmergeOrtho is North Carolina’s premier provider, recognized for offering world-class, comprehensive, and compassionate care serving patients with 67 locations in 28 counties. As the largest physician-owned orthopedic practice in the state and the 2nd in the country, EmergeOrtho’s medical team includes upwards of 190 highly trained orthopedic specialists and nearly as many advanced practice providers. Our subspecialty orthopedic teams offer advanced expertise in conditions of the bones, muscles, and joints. Providing multiple locations, extensive orthopedic services including therapy, and focusing on continuity of care are among the top priorities of EmergeOrtho.

EmergeOrtho, P.A. complies with applicable civil rights laws and does not discriminate based on race, color, religion, national origin, age, sex, gender identity or expression, sexual orientation, pregnancy, childbirth and related conditions, including but not limited to, lactation, disability, veteran status, genetic information, or any other class protected by the state or local law.

We are committed to the core values of Quality, Innovation, Compassion, Community, Education, Integrity, Teamwork, Diversity, and Inclusion. https://emergeortho.com/non-discrimination-notice/

• 401(k) Retirement plan
• Health Insurance
• Dental Insurance
• Vision Insurance
• Flexible spending account
• Health savings account
• Paid time off
• Holiday Pay
• Employee Assistance Program
• Life Insurance
• Short Term Disability
• Long Term Disability
• Pet Insurance
• Milestone Bonus Program
• For more information: https://emergeortho.com/jobs-in-healthcare/our-benefits/

Note: Available benefits based on hours worked per week.