Ortho Surgical Prior Authorization Specialist

OrthoArizona; Chandler (AZ); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Paid time off

Medical with plan options

Health Savings Account

Job summary

OrthoArizona is seeking a Surgical Prior Authorization Specialist in Chandler, AZ to verify insurance requirements, review medical documentation, and submit accurate authorizations. You will manage EMR notes, communicate with providers, and support efficient claim processing.

This role requires healthcare admin experience, strong customer service, and knowledge of practice management software. Join a leading orthopedic practice with comprehensive benefits and a collaborative team environment.

Qualifications

• Excellent customer / patient service.
• Knowledge of medical terminology.
• Excellent written and verbal communication skills.
• Understand/Perform training on practice management software.
• Ability to promote favorable facility image with physicians, patients, insurance companies, and general public.
• Ability to communicate effectively on the telephone.
• Follow all Standard Operating Procedures.
• Minimum of 2 years of healthcare administration experience.

Responsibilities

• Verify insurance authorization requirements for ordered services/ procedures.
• Review documentation or contacts the provider when necessary to supplement the order to prove medical necessity.
• Ensure appropriate documentation is available and complete before submitting the authorization to the insurance company to avoid repetitious submissions and denials.
• Submit all authorizations with correct CPT and diagnosis codes.
• Cross-reference the procedure against the doctor’s orders to ensure all services are submitted correctly.
• Enter any authorization numbers and expiration dates into the EMR for proper claim processing.
• Update pertinent insurance notes in multiple EMR systems for corresponding departments to access.
• Monitor and resolve the status of problem authorizations.
• Fax outgoing imaging orders to corresponding facilities and follow the order to ensure the patient is scheduled.
• Maintain medical records in accordance with practice policies and procedures.
• Estimate prepay amounts due for services and collect co-insurance, copays, deductibles or estimates self-pay rates; prepare daily batch, deposits, etc.
• Using state or federally regulated websites may require personal login credentials.

Skills

Customer service

Medical terminology

Communication skills

Health insurance knowledge

Teamwork

Problem solving

Education

High School diploma or GED

Tools

Practice management software

Job description

OrthoArizona is seeking a Surgical Prior Authorization Specialist in Chandler, AZ to verify insurance requirements, review medical documentation, and submit accurate authorizations. You will manage EMR notes, communicate with providers, and support efficient claim processing.

This role requires healthcare admin experience, strong customer service, and knowledge of practice management software. Join a leading orthopedic practice with comprehensive benefits and a collaborative team environment.