Remote Surgical Authorization Specialist (Pre-Auth)

Austin; Austin, Northern (TX, KY); Hybrid; USD 52,000 - 78,000; Full time

Job summary

Advanced Pain Care is seeking a Surgical Authorization Specialist to verify insurance eligibility, obtain benefits, and ensure pre-certification and referrals are met before services. You will coordinate with payers and clinical partners to document accurate information in the patient record.

The role requires at least three years in billing/pre-authorization or insurance verification, with knowledge of Medicare, Medicaid, HMOs and PPOs, and will involve regular communication with patients and

Qualifications

• Requires a high school diploma or GED.
• Minimum of three years’ experience in billing/pre-authorization or insurance verification.
• Knowledge of Medicare, Medicaid, HMOs and PPOs.

Responsibilities

• Verifies insurance eligibility and benefit levels prior to services.
• Works with payers via electronic, telephonic, and/or fax communication.
• Verifies pre-certification, predetermination, and referral requirements.
• Determines medical necessity with payer policies.
• Communicates with patients and clinical staff to facilitate authorization.
• Submits clean claims and reduces payer denials by following policies.

Skills

Clear communication

Customer relations

Billing terminology

Online insurance portals

Typing skills

Time management

Confidentiality

Education

High school diploma or GED

Tools

None

Job description

Advanced Pain Care is seeking a Surgical Authorization Specialist to verify insurance eligibility, obtain benefits, and ensure pre-certification and referrals are met before services. You will coordinate with payers and clinical partners to document accurate information in the patient record.

The role requires at least three years in billing/pre-authorization or insurance verification, with knowledge of Medicare, Medicaid, HMOs and PPOs, and will involve regular communication with patients and