Orthopedic Prior Authorization Specialist – PTO & Benefits

OrthoArizona; Peoria (AZ); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Basic Life Insurance

Employee Assistance Program

Voluntary Short- & Long-Term Disabilty

401(k) Plan

Paid Time Off

Job summary

OrthoArizona in Peoria, AZ seeks a detail-oriented Prior Authorization Specialist to join a large orthopedic team. You will verify insurance requirements, review documentation for medical necessity, and submit accurate authorizations to insurers using CPT/diagnosis codes.

You will enter authorization data into the EMR, monitor denials, and coordinate with providers to ensure timely scheduling and accurate billing. A 2+ year background in healthcare administration is preferred.

Qualifications

• Minimum of 2 years in healthcare administration or related field.
• Excellent customer service and communication.
• Knowledge of medical terminology and insurance authorization processes.
• Ability to work independently and in a team; strong organizational skills.

Responsibilities

• Verify insurance authorization requirements for ordered services.
• Review documentation to prove medical necessity when needed.
• Submit authorizations with correct CPT and diagnosis codes.
• Enter authorization numbers and expiration dates into the EMR.
• Update insurance notes across EMR systems.
• Monitor and resolve the status of problem authorizations.
• Fax outgoing imaging orders and ensure patient scheduling.
• Maintain medical records per policy and procedures.
• Estimate prepay amounts and collect co-pays, deductibles, or estimates self-pay.

Skills

Customer service

Medical terminology

Computer skills

Verbal communication

Written communication

Practice management software

Telephone etiquette

Problem solving

Insurance knowledge

SOP adherence

Teamwork

Education

High School diploma or GED

Tools

Practice management software

EMR systems

Job description

OrthoArizona in Peoria, AZ seeks a detail-oriented Prior Authorization Specialist to join a large orthopedic team. You will verify insurance requirements, review documentation for medical necessity, and submit accurate authorizations to insurers using CPT/diagnosis codes.

You will enter authorization data into the EMR, monitor denials, and coordinate with providers to ensure timely scheduling and accurate billing. A 2+ year background in healthcare administration is preferred.