Preauthorization Specialist

Orthopedic Surgery and Sports, PLLC; Coeur d'Alene (ID); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Profit sharing

Vision insurance

401(k)

Company parties

Dental insurance

Job summary

Orthopedic Surgery and Sports, PLLC in Idaho is seeking a Billing Specialist to ensure medical criteria are met and obtain timely authorizations from insurers. The role coordinates with schedulers, collects surgery deposits, and documents patient and payer information while supporting a compliant financial process.

The position requires strong communication, billing knowledge, and HIPAA awareness to maintain efficient revenue flow.

Qualifications

• High school diploma or equivalent is required.
• Excellent communication and interpersonal skills are essential.
• Strong knowledge of billing procedures in healthcare.
• Confidence in speaking to patients and collecting surgery deposits.
• Experience in healthcare related to obtaining insurance authorizations.
• Insurance knowledge across commercial, workers' comp and government payers.
• CPT and ICD-10 knowledge is preferred.
• Efficient with basic office equipment and data entry tasks.

Responsibilities

• Coordinate and process medical prior authorizations for surgical procedures.
• Triage calls and requests for service authorizations and status updates.
• Collect surgery deposits and post all payments accurately.
• Communicate professionally with patients, clinic staff and vendors.
• Maintain knowledge of health plan requirements and networks.
• Verify and document insurance information per business practices.
• Post payments from patients, attorney offices and insurers.

Skills

Excellent communication

Billing procedures

Patient communication

Data entry

Typing

10-key skills

Filing

CPT/ICD10 knowledge

Insurance knowledge

Education

High school diploma or equivalent

Job description

Benefits

• Health insurance
• Paid time off
• Profit sharing
• Vision insurance
• 401(k)
• Company parties
• Dental insurance

This position is responsible for ensuring medical criteria is met and obtaining timely authorization from insurance carriers to optimize revenue cash flow. Coordinates with schedulers prior to any procedures to obtain proper authorizations (i.e durable medical equipment, injections, surgeries, etc.). Maintains a working knowledge of our financial system and knowledge of insurance requirements. Responsible for collecting, reviewing, discussing and documenting demographic, insurance and financial information with patients and payers. Collect surgery deposit payments prior to surgery. Makes independent decisions that require individual and/or team analysis, reasoning, and problem solving. Accurately documents interactions and interprets interactions documented by others. Processes accounts and incoming payments in compliance with financial policies and procedures. Provides options for the uninsured or indigent patients (Credit card applications, County Assistance, payment arrangements, etc.) Performs other related duties as assigned.

Essential Job Functions

• Coordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage while ensuring meets medical criteria.
• Able to triage incoming calls and requests from provider groups/patient for authorization of services, questions, status updates
• Collect surgery deposits
• Ensure professional communication with patients, clinic personnel, and outside vendors whether over the phone, via email or other written documentation and respond to all inquiries
• Maintain a working knowledge of health care plan requirements and health plan networks
• Verify and document insurance information as defined by current business practices
• Accurately post all payments received from patients, attorney offices and/or insurance companies

Minimum Qualifications

• 1. High school diploma or equivalent.
• 2. Excellent communication and interpersonal skills
• 3. Excellent knowledge of billing procedures
• 4. Requires confidence in speaking to patients and asking for surgery deposits prior to surgery
• 4. Previous experience in healthcare in relation to obtaining insurance authorizations
• 5. Insurance knowledge in commercial, work comp, and government payers required
• 6. CPT and ICD10 knowledge preferred
• 7. Efficient in the use of standard office equipment, data entry, typing, 10-key skills, and alpha/numerical filing.

Essential Functions (Physical)

• Regular and predictable attendance is an essential job function.
• Majority of the shift is spent sitting.
• Frequent reaching, stooping and twisting when filing, accessing records and answering telephone
• Ability to lift up to 25 pounds.
• Read a variety of printed and handwritten materials, computerized reports, manuals, and correspondence.
• Communicates with patients, physicians, families and co-workers in person and on the telephone.
• Comply with company policies, procedures, practices and business ethics guidelines.
• Complete job required training.
• Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
• Work in the office during business hours
• Work at an efficient and productive pace, handle interruptions appropriately and meet deadlines
• Communicate and interact in a respectful and professional manner
• Prioritize workload while being flexible to meet the expectations of the daily operations
• Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions
• Understand and execute a variety of instructions
• Work independently with minimal supervision

Work Environment

• Orthopedic Surgery & Sports Medicine operates in a professional office environment. Days and hours of work are conducted Monday thru Friday 8:00 am to 5:00 pm.
• This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
• Orthopedic Surgery & Sports Medicine has multiple locations and travel may be required.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.