RCM Authorizations Representative

Sports Medicine North; Stamford (CT); Remote; USD 30.000 - 45.000; Vollzeit

Zusammenfassung

Spire Orthopedic Partners is seeking an experienced RCM Authorizations Representative to review authorization requirements for surgeries, therapies, imaging and DME. You will coordinate with outsourced auth vendors, clinical staff and scheduling teams to ensure timely approvals and smooth patient care.

The role emphasizes accurate documentation, confidentiality, and strong communication with providers and patients, with a fully remote work arrangement.

Qualifikationen

• Minimum of one-year prior authorization experience required.
• Knowledge of Orthopedic procedures helpful but not essential.
• Excellent telephone etiquette and good communication skills (written and oral).
• Computer literacy skills preferred, including practice management software, EMR, Microsoft Word and Excel.
• Detail oriented and strong organizational skills preferred.
• Familiar with Local Coverage Insurance Plans.

Aufgaben

• Review EHR task lists to determine authorization requirements for Commercial Surgery, Physical Therapy, MRI/CT Scans, Injections/VISCO and DME/Bone Stimulators.
• Review orders and dictations in EHR regarding requests and keep lists updated.
• Document correspondence/updates on orders with status.
• Notify providers and arrange Peer to Peer requests and follow up on outcomes.
• Inform Clinical and Radiology staff of changes to authorization requirements.
• Serve as direct contact for outsourced authorization companies to ensure timely turnaround per contract.
• Coordinate with Operations leadership and PCCs on scheduling needs.
• Provide resource for the team; be the first line of response to workflow issues and inform staff of changes.
• Maintain auth team task list and confidentiality of patient data in EMR.
• Communicate with providers and patients; monitor team communication and decision making.
• Support scheduling and patient care with RCM and Operational teams.

Kenntnisse

Telephone etiquette

Communication skills

Ausbildung

High school diploma or equivalent

Tools

Practice management software

EMR

Microsoft Word

Excel

Jobbeschreibung

RCM Authorizations Representative# RCM Authorizations RepresentativeFully Remote • MSO Corporate 1000 - Stamford, CT 06905## OverviewSalary Range$21.85 - $32.75 HourlyLevelExperiencedPosition TypeFull TimeJob ShiftDayEducation LevelNot SpecifiedTravel PercentageNoneCategoryHealth Care## Description**Who we are:** Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most – patient care. Headquartered in Stamford, Connecticut, the Spire network spans the Northeast with more than 165 physicians, 1,800 employees, 285 other clinical providers and 40 locations in New York, Connecticut, Rhode Island and Massachusetts.**What you’ll do:** **Responsibilities/Duties:*** Review the EHR task lists for the following services/tests to determine authorization requirements: + Commercial Surgery + Physical Therapy + MRI/CT Scans + Injections/VISCO + DME/Bone Stimulators* Review all orders and necessary dictations in EHR regarding request.* Keep each list updated to ensure timely requests are sent.* Document all correspondence/updates on each order with the status as it becomes available.* Notify providers and arrange Peer to Peer requests and follow up on outcome.* Notify Clinical and Radiology staff of any changes with authorization requirements.* Act as the direct point of contact for outsourced authorization companies to ensure appropriate turnaround times are being supported per contract.* Communicate scheduling needs with the Dir. Of Operations, Office Managers and PCC’s.* Act as a resource for the team, be the first line response to procedural and workflow issues and keep the staff informed of procedure and workflow changes.* Maintain auth team task list.* Maintain a professional work atmosphere through behavior and communication with patients, physicians, coworkers and administration.* Works directly with RCM and Operational Teams to ensure proper scheduling and patient care. Includes monitoring team communication and decision making.* Creates, updates, and accesses confidential patients’ data in EMR with high level of confidentiality and accuracy.* Main contact for all Provider correspondence and patient issues.* Demonstrate the ability to prioritize and multi-task.## Qualifications**Who you are:****Qualifications:*** Minimum of one-year prior authorization experience required.* Knowledge of Orthopedic procedures help, but not essential.* Excellent telephone etiquette and good communication skills (written and oral).* Computer literacy skills preferred, including practice management software, EMR, Microsoft Word and Excel.* Detail oriented and strong organizational skills preferred.* High school diploma or equivalent.* Familiar with Local Coverage Insurance Plans**What we offer:*** Excellent growth and advancement opportunities* Dynamic environment* Access to a diverse network of practitioners* Broad infrastructure of tools and programs to enhance employee experience* Competitive Compensation* Generous PTO* Benefits package: health, dental, vision, 401(k), etc.***We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).***