Prior Authorization Specialist – Orthopedic Care

OrthoArizona; Peoria (AZ); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Robust paid time off

Medical with multiple plan options

Health Savings account

Dental & Vision Insurance

401(k)

Pet Discount Plan

ID Theft Protection & Legal Assistance

Job summary

OrthoArizona is seeking a Prior Authorization Specialist in Peoria, AZ to verify insurance requirements, secure medical necessity documentation, and submit accurate authorizations. You will work with physicians, staff, and insurance companies to ensure timely approvals and proper coding.

Responsibilities include EMR data entry, patient communication, and maintaining records in line with policies. A minimum of 2 years in healthcare admin plus familiarity with practice management software are

Qualifications

• Excellent customer / patient service.
• Knowledge of medical terminology.
• 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.

Responsibilities

• Verify insurance authorization requirements for ordered services/ procedures.
• Review documentation or contact the provider to prove medical necessity.
• Ensure documentation is complete before submitting authorization to the insurer.
• Submit authorizations with correct CPT and diagnosis codes.
• Cross-reference procedures with doctor orders to ensure correct submission.
• Enter authorization numbers and expiration dates into the EMR.
• Update insurance notes in EMR systems for relevant departments.
• Monitor and resolve status of problem authorizations.
• Fax outgoing imaging orders and ensure patient scheduling.
• Maintain medical records per practice policies.
• Estimate prepay amounts due and collect co-insurance and deductibles.
• Use state or federally regulated websites as needed.

Skills

Customer service

Medical terminology

Communication

EMR systems

Telephone communication

Problem solving

Education

High School diploma or GED

Tools

Practice management software

EMR systems

Job description

OrthoArizona is seeking a Prior Authorization Specialist in Peoria, AZ to verify insurance requirements, secure medical necessity documentation, and submit accurate authorizations. You will work with physicians, staff, and insurance companies to ensure timely approvals and proper coding.

Responsibilities include EMR data entry, patient communication, and maintaining records in line with policies. A minimum of 2 years in healthcare admin plus familiarity with practice management software are