Healthcare Pre-Auth Navigator

Orthopaedic Associates of Wisconsin; City of Pewaukee (WI); Remote; USD 25.000 - 33.000; Vollzeit

Zusammenfassung

Orthopaedic Associates of Wisconsin is seeking a Pre-Authorization Specialist to verify insurance eligibility, obtain benefits, and secure pre-certifications, authorizations, and referrals before services are delivered.

You will liaise with patients, providers, and insurers, document all verifications and authorizations in the EHR (EPIC), and ensure compliance with policies and regulations. This is an office-based role in a collaborative orthopedic environment.

Qualifikationen

• High School Diploma or equivalent.
• Minimum two years of experience in medical insurance verification, pre-authorization, or a related role.
• Experience in an orthopedic or surgical setting preferred.
• Proficiency in using electronic health records (EHR) and insurance verification software (EPIC and MS Office preferred).

Aufgaben

• Obtain authorizations and pre-determinations from insurance companies for all required services.
• Receive verification of benefits from insurance and confirm patient eligibility via direct contact and online portals.
• Enter new/updated patient information into the system and ensure documentation is complete and submitted promptly.
• Determine payer authorization requirements and provide status updates to relevant parties.
• Track pre-authorizations daily and alert admins before due dates; support clinical staff to ensure timely completion.
• Document information in patient records and ensure referrals are in place when needed; maintain records of verifications, authorizations, and referrals.
• Liaise with patients, providers, and insurers to resolve coverage and authorization issues.
• Ensure all actions comply with hospital policies, regulations, and guidelines.
• Perform other office duties when backup coverage is needed.

Kenntnisse

Verbal and written communication

Attention to detail

Problem solving

Ausbildung

High School Diploma or equivalent

Tools

EPIC

Microsoft Office

EHR systems

Jobbeschreibung

Orthopaedic Associates of Wisconsin is seeking a Pre-Authorization Specialist to verify insurance eligibility, obtain benefits, and secure pre-certifications, authorizations, and referrals before services are delivered.

You will liaise with patients, providers, and insurers, document all verifications and authorizations in the EHR (EPIC), and ensure compliance with policies and regulations. This is an office-based role in a collaborative orthopedic environment.