Surgery Authorization Specialist

Boulder, CO; Boulder, Northern (CO, KY); Hybrid; USD 28,000 - 39,000; Full time

Job summary

BoulderCentre for Orthopedics & Spine is seeking a Surgery Prior Authorization Specialist to join our Revenue Cycle team. This position plays an important role in ensuring surgical procedures are properly authorized and financially prepared before a patient's scheduled surgery.

The ideal candidate is highly organized, detail-oriented, and comfortable working with insurance carriers, providers, clinical staff, and surgery schedulers.

Qualifications

• High school diploma or GED.
• At least 2 years of experience in medical insurance, prior authorization, medical billing, revenue cycle, or a related healthcare setting.
• Experience working with insurance companies and payer portals.
• Strong knowledge of insurance benefits and prior authorization processes.
• Knowledge of CPT and ICD-10 coding.
• Strong attention to detail and organizational skills.
• Ability to manage multiple cases and deadlines in a fast-paced environment.
• Excellent written and verbal communication skills.
• Proficiency with computers, electronic medical records/practice management systems, and web-based insurance portals.

Responsibilities

• Obtain and manage prior authorizations for surgical procedures.
• Verify insurance eligibility, benefits, authorization requirements, and payer-specific guidelines.
• Review surgical orders and supporting clinical documentation to ensure you meet authorization requirements.
• Submit authorization requests through payer portals, by phone, or through other required processes.
• Track pending authorizations and follow up with insurance carriers to ensure timely determinations.
• Identify authorization requirements, site-of-service restrictions, and other payer guidelines that may impact surgical scheduling.
• Ensure surgical procedures are scheduled at the appropriate facility based on insurance requirements and medical necessity criteria.
• Identify cases requiring hospital versus ambulatory surgery center (ASC) scheduling based on payer restrictions or procedure requirements.
• Communicate authorization status, restrictions, denials, or potential delays to surgery schedulers, providers, clinical staff, and other appropriate team members.
• Proactively identify missing information or documentation and coordinate with providers and clinical staff to obtain what is needed.
• Escalate complex, urgent, or high-risk authorization issues as appropriate.
• Assist with denied, delayed, retroactive, and appeal requests as needed.
• Maintain accurate and timely documentation of authorization activity in the appropriate systems.
• Perform insurance verification and assist with determining patient financial responsibility for scheduled surgical services.
• Review deductibles, coinsurance, out-of-pocket maximums and applicable benefits to support accurate patient cost estimates.
• Communicate with patients regarding estimated financial responsibility and pre-service requirements when applicable.
• Coordinate with surgery schedulers, billing staff, providers, facilities, and insurance carriers to ensure surgical cases are financially and administratively in compliance.
• Monitor surgical readiness and notify appropriate team members of missing authorizations, unresolved financial requirements or other issues that affect scheduling.
• Maintain knowledge of changing payer requirements, authorization processes and insurance guidelines.
• Support departmental productivity, accuracy, timeliness and revenue cycle goals.
• Perform other duties and responsibilities as assigned.

Skills

Prior authorization

Insurance knowledge

Medical terminology

Attention to detail

Communication skills

EMR systems

Time management

CPT/ ICD-10

Office software

Education

High school diploma or GED

Tools

EMR/PM systems

Job description

BoulderCentre for Orthopedics & Spine is seeking a Surgery Prior Authorization Specialist to join our Revenue Cycle team. This position plays an important role in ensuring surgical procedures are properly authorized and financially prepared before a patient's scheduled surgery.

The ideal candidate is highly organized, detail-oriented, and comfortable working with insurance carriers, providers, clinical staff, and surgery schedulers.