Orthopedics Surgical Authorization Specialist

Socket.dev; Boulder (CO); On-site; USD 2,755,000 - 3,857,000; Full time

Job summary

BoulderCentre for Orthopedics & Spine is seeking a Surgery Prior Authorization Specialist to join the Revenue Cycle team. This role ensures surgical procedures are properly authorized and financially prepared before a patient’s scheduled surgery.

The ideal candidate is highly organized, detail-oriented, and comfortable working with insurance carriers, providers, clinical staff, and surgery schedulers. Strong knowledge of payer requirements and ability to manage multiple authorizations is

Qualifications

• High school diploma or GED.
• At least 2 years of experience in medical insurance, prior authorization, medical billing, revenue cycle, or related healthcare setting.
• Experience with insurance companies and payer portals.
• Strong knowledge of insurance benefits and prior authorization processes.
• Knowledge of CPT and ICD-10 coding.
• Attention to detail and organization.
• Ability to manage multiple cases and deadlines in a fast-paced environment.
• Excellent written and verbal communication skills.

Responsibilities

• Obtain and manage prior authorizations for surgical procedures.
• Verify insurance eligibility, benefits, authorization requirements, and payer guidelines.
• Review surgical orders and documentation to meet authorization requirements.
• Submit authorization requests through payer portals, by phone, or other required processes.
• Track pending authorizations and follow up with carriers for timely determinations.
• Identify requirements and guidelines impacting surgical scheduling.
• Ensure procedures are scheduled at appropriate facility based on insurance requirements.
• Escalate complex or urgent authorization issues as appropriate.
• Maintain accurate documentation of authorization activity in systems.
• Assist with determining patient financial responsibility for scheduled services.

Skills

Attention to detail

Communication skills

Multi-tasking

Medical terminology

Education

High school diploma or GED

Tools

EMR systems

Practice management systems

Payer portals

Job description

BoulderCentre for Orthopedics & Spine is seeking a Surgery Prior Authorization Specialist to join the Revenue Cycle team. This role ensures surgical procedures are properly authorized and financially prepared before a patient’s scheduled surgery.

The ideal candidate is highly organized, detail-oriented, and comfortable working with insurance carriers, providers, clinical staff, and surgery schedulers. Strong knowledge of payer requirements and ability to manage multiple authorizations is