Surgery Authorization Specialist

StrideCare; United States; On-site; USD 42,000 - 65,000; Full time

Job summary

StrideCare is seeking a Financial Clearance Specialist to manage pre-appointment insurance processes, including benefits verification, cost estimates, and prior authorizations. You will document details in Athena and coordinate with the clinical team to ensure timely approvals.

The role requires strong communication, multitasking, and attention to detail, with a focus on HIPAA compliance and patient-centered service in a fast-paced environment.

Qualifications

• Requires a High School diploma or GED; Medical Assistant Certification preferred.
• Strong knowledge of insurance coverage and benefits criteria.
• Ability to verify benefits, estimate costs, and obtain authorizations.

Responsibilities

• Verify insurance benefits for patients and document details in Athena.
• Understand criteria for treatments and authorization requirements.
• Review clinical records to confirm criteria for authorization.
• Initiate pre-authorization/predetermination with insurance, submitting docs.
• Monitor status of surgical reviews and follow protocols.
• Document determinations after authorization requests.
• Manage patient cases through insurance review and authorization.
• Communicate adverse determinations to clinic staff promptly.
• Create cost estimates for procedures including self-pay options.
• Maintain log of procedures ordered and under review.
• Process incoming/outgoing faxes related to authorizations.
• Handle calls with patients and insurers regarding authorizations.
• Contact patients to schedule procedures and review estimates.
• Provide pre/post-operative instructions for specific surgeries.
• Collaborate with clinical team on benefits, estimates, and authorizations.
• Provide training support to team members as needed.

Skills

Benefits verification

Problem solving

Communication

HIPAA compliance

Independent work

Multitasking

Microsoft Office

Athena EMR

Education

High School Diploma or GED

Medical Assistant Certification (preferred)

Tools

Athena EMR

Job description

StrideCare is seeking a Financial Clearance Specialist to manage pre-appointment insurance processes, including benefits verification, cost estimates, and prior authorizations. You will document details in Athena and coordinate with the clinical team to ensure timely approvals.

The role requires strong communication, multitasking, and attention to detail, with a focus on HIPAA compliance and patient-centered service in a fast-paced environment.