Prior Authorization Specialist

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

Anticipate patient needs, exceed expectations, and create lifelong memories.

An orthopedic practice that is made up of over 70 premier specialists, specializing in sports medicine, joint replacement, arthroscopy, fractures, arthritis, and general orthopedic conditions in adult and pediatric patients. OrthoArizona offers a wide variety of services that include advanced imaging, physical therapy, diagnostic testing, casting, durable medical equipment, and workers’ compensation.

We are looking for employees who want to work for a fast-growing organization with a strong reputation for providing comprehensive, high-quality musculoskeletal care. We need professionals who share our vision and the commitment to see it through.

General Employee Benefits

We are committed to providing the best benefits options to our employees so we can support their health, wellness, and happiness.

Basic Life Insurance

Employee Assistance Program

Voluntary Short- & Long-Term Disability

401(k) Plan

Paid Time Off

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.