Orthopedic Prior Authorization Specialist | Patient Care

OrthoArizona; Peoria (AZ); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

PTO, holidays & sick time

Medical plans

HSA with company contributions

Dental & Vision

401(k)

Pet Discount Plan

ID Theft Protection

Job summary

OrthoArizona is seeking an experienced Prior Authorization Specialist to verify insurance requirements for services, ensure medical necessity, and submit accurate authorizations with CPT/diagnosis codes. You will enter data into EMR, track authorization statuses, and maintain records across systems, while upholding SOPs and delivering patient-centered service.

The role requires 2+ years in healthcare administration, strong terminology knowledge, and excellent communication.

Qualifications

• Excellent customer/patient service.
• Knowledge of medical terminology.
• Excellent written and verbal communication skills.
• Understand/train on practice management software.
• Promote favorable facility image with physicians, patients, insurance companies, and general public.
• Communicate effectively on the telephone.
• Make decisions and solve problems.
• Understand health insurance plans including reading plan requirements.
• Follow all Standard Operating Procedures.
• High School diploma or GED.
• Minimum of 2 years of experience in healthcare administration or related field.
• Strong organizational and communication skills.
• Ability to work independently and as part of a team.
• Knowledge of medical terminology and insurance authorization processes.

Responsibilities

• Verify insurance authorization requirements for ordered services/procedures.
• Review documentation or contact the provider to prove medical necessity.
• Submit authorizations with correct CPT and diagnosis codes.
• Cross-reference procedures with doctor's orders for correct submissions.
• Enter authorization numbers and expiration dates into the EMR.
• Update insurance notes in multiple EMR systems.
• Monitor and resolve the status of problem authorizations.
• Fax imaging orders to facilities and ensure patient scheduling.
• Maintain medical records per practice policies.

Skills

Customer service

Medical terminology

Communication skills

Practice management software

Problem solving

Insurance knowledge

Telephone communication

SOP adherence

Teamwork

Independent work

EMR/records entry

Attention to detail

Education

High School diploma or GED

Tools

Practice management software

EMR systems

Job description

OrthoArizona is seeking an experienced Prior Authorization Specialist to verify insurance requirements for services, ensure medical necessity, and submit accurate authorizations with CPT/diagnosis codes. You will enter data into EMR, track authorization statuses, and maintain records across systems, while upholding SOPs and delivering patient-centered service.

The role requires 2+ years in healthcare administration, strong terminology knowledge, and excellent communication.