Authorization Specialist

Premier Orthopaedics; Media (Delaware County); On-site; USD 38,000 - 54,000; Full time

Job summary

Premier Orthopaedics and Philadelphia Hand to Shoulder Center are leading providers of musculoskeletal care with locations across PA, NJ and DE. This role supports the surgical authorization workflow, patient eligibility verification, and cost analysis to ensure timely, accurate processing of cases.

The position requires strong organizational skills, effective communication with physicians and patients, and experience with referrals/authorizations in a healthcare setting.

Qualifications

• High school diploma/GED or equivalent working knowledge preferred.
• Minimum of 2 years’ experience in 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 strong background with computers and data entry.
• 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.

Responsibilities

• Monitors authorizations for upcoming surgical cases on physician calendars.
• Verifies patient demographics and insurance eligibility.
• Completes surgical cost analysis form and documents required cost estimation.
• Verifies benefits on Visco injections.
• Documents authorizations in patient charts and enters information within case management.
• Communicates effectively with physicians, patients, and co-workers to maintain good working relationships.
• Participates in staff training on new processes for timely confirmation of surgical cases.
• Works with department manager to respond to and reduce complaints professionally.
• Assists surgery schedulers with STAT authorizations.

Skills

Effective communication

Customer service

Data entry

Computer literacy

Eligibility verification

Prior authorizations

Education

High school diploma/GED

Tools

Computer applications

Eligibility systems

Job description

Essential Functions

• Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for Viscosupplementation injections are obtained in a timely and accurate manor.
• 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 Visco injections.
• Document’s 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.

Essential Functions

• Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for Viscosupplementation injections are obtained in a timely and accurate manor.
• 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 Visco injections.
• Document’s 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.

Education

• High school diploma/GED or equivalent working knowledge preferred
• Minimum of 2 years’ experience in 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 strong background with computers and data entry.
• 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.

About Premier Orthopaedics & Philadelphia Hand To Shoulder

Premier Orthopaedics and Philadelphia Hand to Shoulder Center (PHSC) are leading providers of comprehensive musculoskeletal care throughout Pennsylvania, New Jersey and Delaware.

Premier Orthopaedics delivers expert treatment for orthopedic injuries, joint disease, interventional spine care, regenerative medicine, and comprehensive physical therapy services, supported by more than 1200 providers across 50+ locations. Our facilities include state-of-the-art MRI centers, outpatient surgery centers, physical therapy clinics, and orthopedic urgent care centers to ensure timely access to high-quality, patient-focused care.

Philadelphia Hand to Shoulder Center (PHSC), a division of Premier Orthopaedics, has been nationally recognized for more than 50 years for its specialized care of the hand, wrist, elbow, arm, and shoulder. Our fellowship-trained surgeons and certified Hand and Occupational Therapists collaborate to provide seamless care- from diagnosis and treatment to post-operative and rehabilitative recovery. With 20+ convenient locations across Pennsylvania and New Jersey, PHSC offers advanced, integrated care to restore function, mobility, and quality of life for patients with upper extremity conditions.