Complex Case Insurance Authorization Coordinator

Summit Spine and Joint Centers; Lawrenceville (GA); On-site; USD 42,000 - 54,000; Full time

Job summary

Summit Spine and Joint Centers in Lawrenceville, GA is seeking a Complex Case Insurance Authorization Coordinator to handle authorizations for complex surgical procedures including SCS trials and implants. Under general supervision, you will coordinate with providers and payors to secure approvals and document financial responsibilities.

The role requires at least 2 years in an outpatient medical office with CPT/ICD-10 knowledge, familiarity with Medicare and commercial insurance, and experience

Qualifications

• Minimum 2 years' experience in outpatient medical office in an Insurance Authorization or Pre Authorization /Certification role.
• Excellent knowledge of CPT coding, ICD.10 coding and medical pre-certification protocols required
• Authorization portal experience preferred
• Experience in Pain Management preferred
• Experience using eClinicalWorks preferred
• Bilingual candidates encouraged to apply

Responsibilities

• Routinely provide patients with other clinic and community-based resource materials as appropriate.
• Research, follow up and resolve open & pending procedure authorizations in a timely manner
• Verify insurance eligibility and benefits of prospects/referrals
• Comfortable working in a growing organization and able to navigate change.
• Address insurance related patient concerns
• Self-motivated with the ability to multi-task and prioritize work in a fast-paced team environment
• Review schedule ahead of time to determine pre-certification and prior authorization requirements.
• Obtain authorizations by using online applications or by contacting insurance company directly.
• Must be familiar with Medicare and Commercial Insurances.
• Maintain organized working files of all authorization requests and enter approved authorizations into the system.
• Coordinate and document all financial responsibilities related to patient deductibles, coinsurance, and copays owed at the time of service.

Skills

Multitasking

Detail oriented

Verbal communication

Written communication

Bilingual

Tools

Authorization portal

eClinicalWorks

Job description

Position:Complex Case Insurance Authorization Coordinator

Location: Lawrenceville, GA

Job Id:4637

# of Openings:1

Company Overview

Summit Spine and Joint Centers (SSJC) is a rapidly growing, multi-state Interventional Pain Management group practice providing integrated clinical, surgical, and imaging services. With clinic locations across Georgia, North Carolina, South Carolina, and Tennessee, our care teams include Integrated Pain Solutions in North Carolina and Savannah Pain Management in Georgia, all operating as part of the SSJC organization. As one of the largest single-specialty practices in the nation, we are committed to collaboration, high-quality patient-centered care, and supporting our teams as we continue to expand. We are seeking motivated, qualified professionals to join us in delivering exceptional care across our growing network.

Summary of Position

Under general supervision of a licensed provider, as a Complex Case Insurance Authorization Coordinator one must perform insurance authorizations for complex surgical procedures such as SCS trials and implants, Vertiflex implants, SI Joint Fusions, NALU/Sprint Peripheral Nerve Stimulators, Intracepts, VIA DISCs, etc . We are seeking motivated individuals who can problem-solve and mult itask as we are a fast-paced practice. Gain skills and knowledge of org anization policies and procedures in support of the department.

This job is a full-time, benefited position at Summit Spine & Joint Centers that reports to the Director of Operations. This position’s primary location will be at the Administrative Building in Lawrenceville, GA.

Responsibilities

• Routinely provide patients with other clinic and community-based resource materials as appropriate.
• Research, follow up and resolve open & pending procedure authorizations in a timely manner
• Verify insurance eligibility and benefits of prospects/referrals
• Comfortable working in a growing organization and able to navigate change.
• Address insurance related patient concerns
• Self-motivated with the ability to multi-task and prioritize work in a fast-paced team environment
• Review schedule ahead of time to determine pre-certification and prior authorization requirements.
• Obtain authorizations by using online applications or by contacting insurance company directly.
• Must be familiar with Medicare and Commercial Insurances.
• Maintain organized working files of all authorization requests and enter approved authorizations into the system.
• Coordinate and document all financial responsibilities related to patient deductibles, coinsurance, and copays owed at the time of service.

Skills And Abilities

• Must be personable and detail oriented as a representative of the practice while callers rely on proper information
• Excellent verbal and written skills for proper documentation of encounters.
• Bilingual candidates are encouraged to apply

Education And Experience

• Minimum of 2 years' experience in an outpatient medical office, working in an Insurance Authorization or Pre Authorization /Certification role.
• Excellent knowledge of CPT coding, ICD.10 coding and medical pre-certification protocols required
• Authorization portal experience preferred
• Experience in Pain Management preferred
• Experience using eClinicalWorks preferred

The employee must communicate professionally, respectfully, and effectively with patients, visitors, clinicians, coworkers, and vendors, including in busy, demanding, or stressful circumstances. The employee must maintain professional composure and consistently perform assigned duties throughout the scheduled work period; manage routine workplace stressors and feedback without disrupting patient care, patient-facing operations, or coworkers’ work; and use established de-escalation and escalation procedures when appropriate. The employee must exercise sound judgment; maintain appropriate workplace boundaries; receive and respond to routine feedback and direction; protect confidential patient and business information; and address patient or workplace concerns through established supervisory and safety procedures. These functions are essential to the position.