Authorization Specialist

Mt. Washington Pediatric Hospital; Pine Valley Estates (NC); Hybrid; USD 42,000 - 56,000; Full time

Job summary

EmergeOrtho in North Carolina’s Coastal region is seeking an Authorizations Specialist to join the Ashton office. You will obtain and apply all required authorizations, confirm insurance eligibility, and liaise with physicians, case managers, and carriers to secure timely approvals.

The ideal candidate has strong attention to detail, experience in insurance billing/coding, excellent communication, and proficiency with electronic medical records.

Qualifications

• High school diploma or equivalent.
• Experience in insurance billing and coding is required.
• Minimum two years of patient service experience in healthcare.
• Excellent communication and interpersonal skills.
• Excellent organizational skills and attention to detail.
• Experience using electronic medical records systems (EMR).

Responsibilities

• Obtains orders from the physician.
• Logs all orders in EMR for accurate tracking and scheduling.
• Eligibility, benefits, and authorization are obtained online or via telephone.
• Respond to clinical requests with accurate information; follow up within 3 business days.
• Schedule peer-to-peer reviews with physician and insurer when needed.
• Faxing patient information to outside providers when referred out.
• Follow up on requests within 7–10 days to confirm receipt and appointments.
• Process diagnostic orders within 3–5 days; STAT orders are expedited.
• Obtain surgical authorizations 10 days prior to surgery date unless STAT.
• Maintain electronic log sheet for physical therapy patients with demographics and caps.
• Maintain clinic and patient confidentiality.
• Perform other duties as assigned by Manager.

Skills

Insurance billing

Medical coding

Patient service

Communication skills

Organizational skills

Integrity & confidentiality

Education

High school diploma or equivalent

Tools

EMR systems

Job description

• Job Category Non-Clinical
• Employee Type Full-Time

Description

Bring Compassion to the Coast: Hiring for an Authorizations Specialist Now!

EmergeOrtho is committed to being the trusted leader in innovative, quality-focused comprehensive musculoskeletal care. With offices across North Carolina, the Coastal region is seeking an Authorizations Specialist to join their team in our Ashton office. 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.

Why Join EmergeOrtho?

• Great Team - Join a collaborative, supportive group that values your contributions
• Potential for Remote Work - Primarily an in-office role with the possibility of remote flexibility in the future

Who Should Apply?

If you're a detail-oriented professional who excels in a dynamic healthcare environment, values teamwork, and is passionate about ensuring patients receive timely and accurate care through efficient authorization processes, we want to hear from you! Be part of something bigger.

Requirements

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 . Please visit https://emergeortho.com/careers/ for additional information.

EmergeOrtho, P.A. complies with applicable civil rights laws and does not discriminatebased onrace, 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.

Note: Available benefits based on hours worked per week.