Pre-Authorization Specialist – Orthopedics Office

Excelsior Orthopaedics Group; Town of Amherst (NY); On-site; USD 27,000 - 49,000; Full time

Job summary

Excelsior Orthopaedics Group in Amherst, NY is seeking a full-time Authorization Specialist to obtain pre-authorizations and certifications per payer requirements, ensuring documentation in the system. You will support patients, providers, and staff with authorization-related tasks.

Knowledge of CPT/HCPCS/ICD-10 codes and medical terminology is required, with EMR experience (MEDENT preferred). The role involves discussing co-pays and deductibles, maintaining accuracy and efficiency in a

Qualifications

• High school degree or equivalent.
• Knowledge of CPT, HCPCS, and ICD-10 codes highly preferred.
• Medical terminology required.
• Ability to prioritize and perform multiple tasks with interruptions.
• EMR experience required; MEDENT preferred.

Responsibilities

• Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the system.
• Verifies physician orders are accurate.
• Explain insurance co-pays, deductibles, co-insurances, and out-of-pocket expenses for point-of-service collections.
• Communicate authorization status with providers, clinical staff, and patients.
• Assist billing in researching and resolving rejected or denied claims.
• Maintain professional environment for patients, families, and staff.
• Stay current with authorization requirements and billing policies.
• Inform management of changes in authorization processes and codes.

Skills

Insurance knowledge

Attention to detail

Multitasking

Education

High school diploma

Tools

MEDENT EMR

Job description

Excelsior Orthopaedics Group in Amherst, NY is seeking a full-time Authorization Specialist to obtain pre-authorizations and certifications per payer requirements, ensuring documentation in the system. You will support patients, providers, and staff with authorization-related tasks.

Knowledge of CPT/HCPCS/ICD-10 codes and medical terminology is required, with EMR experience (MEDENT preferred). The role involves discussing co-pays and deductibles, maintaining accuracy and efficiency in a