Prior Authorization Specialist

OrthoArizona; Chicago (IL); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

PTO and holidays

Medical insurance

Health Savings Account

Job summary

OrthoArizona in Peoria, AZ, is seeking a Prior Authorization Specialist to verify insurance requirements and ensure medical necessity documentation is complete for submissions.

You will submit authorizations with correct CPT/diagnosis codes, update EMR notes, and monitor statuses while coordinating with physicians, patients, and payers. The role demands strong communication, organization, and knowledge of health insurance plans.

Qualifications

• Excellent customer / patient service and communication skills.
• Knowledge of medical terminology.
• Ability to promote favorable facility image with physicians, patients, insurance companies and public.
• Understand/perform training on practice management software.
• Minimum of 2 years of experience in healthcare administration or related field.

Responsibilities

• Verify insurance authorization requirements for ordered services/procedures.
• Review documentation or contact the provider to supplement the order and prove medical necessity.
• Submit authorizations with correct CPT and diagnosis codes.
• Cross-reference procedures with doctor’s orders to ensure accuracy.
• Enter authorization numbers and expiration dates into the EMR.
• Update insurance notes in multiple EMR systems for departments to access.
• Monitor and resolve the status of problem authorizations.
• Fax imaging orders to facilities and ensure patient scheduling.
• Maintain medical records per policy.
• Estimate prepay amounts and collect co-insurance, copays, deductibles, or self-pay estimates.

Skills

Customer service

Communication

Problem solving

Telephone communication

Teamwork

Medical terminology

Education

High school diploma or GED

Tools

EMR systems

Practice management software

Job description

Position:Prior Authorization Specialist

Location: Peoria (West Admin Hub), AZ

Job Id:4105

# of Openings:1

Prior Authorization Specialist

About OrthoArizona:

At OrthoArizona, we are bringing the best together. Our organization was created to help serve ALL orthopedic and podiatry needs throughout the Valley! We have a wide range of orthopedic surgeons and mid-level providers including physical and occupational therapists.

Today we are one of Arizona’s largest privately owned and most comprehensive orthopedic practices with more than 75 locally and nationally renowned providers across 30 locations, in addition to 2 ambulatory surgical centers and in house state of the art MRI capabilities. At OrthoArizona we are committed to best-in-class patient care, being a pioneer in research and technology, and most importantly, rewarding and recognizing our employees.

As an Prior Authorization Specialist with OrthoArizona, you will get to:

• Verify insurance authorization requirements for ordered services/ procedures.
• Reviews documentation or contacts the provider when necessary to supplement the order to prove medical necessity.
• Ensures appropriate documentation is available and complete before submitting the authorization to the insurance company to avoid repetitious submissions and denials.
• Submits all authorizations with correct CPT and diagnosis codes.
• Cross-references the procedure tasked against the doctor’s orders to ensure all services are submitted correctly.
• Enters any authorization numbers and expiration dates into the EMR for proper claim processing.
• Update pertinent insurance notes in multiple EMR systems for corresponding departments to access.
• Monitors and resolves the status of problem authorizations.
• Faxes outgoing imaging orders to corresponding facilities and follows the order to ensure the patient is scheduled.
• Maintain medical records in accordance with practice policies and procedures.
• Estimates prepay amounts due for services and collects co-insurance, copays, deductibles or estimates self-pay rates; prepares daily batch, deposits, etc.
• *Using state or federally regulated websites may require personal login credentials.

Qualifications:

• Excellent customer / patient service. Knowledge of medical terminology.
• Working knowledge of computer programs.
• Excellent written and verbal communication skills.
• Understand/Perform training on practice management software.
• Ability to promote favorable facility image with physicians, patients, insurance companies, and general public.
• Ability to communicate effectively on the telephone.
• Ability to make decisions and solve problems.
• Working knowledge of 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.

Full Time Benefits:

• Robust paid time off package including, sick time, holidays, & paid time off!
• Medical with multiple different plan options.
• Health Savings account + company contributions.