Surgery Coordinator

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

Description

Job Summary:

The Financial Clearance team is responsible for managing all pre-appointment insurance processes including benefits verification, cost estimates, and prior authorizations.

Supervisory Responsibilities:

N/A

Essential Duties / Responsibilities:

• - Verify insurance benefits for all patients and accurately document details in Athena.
• - Understand insurance criteria and requirements for various treatments.
• - Review clinical records to confirm that criteria are met for authorization.
• - Initiate pre-authorization or predetermination requests with insurance companies, submitting all necessary clinical documentation via fax or portal.
• - Monitor the status of surgical reviews according to established protocols.
• - Document authorization request determinations following protocol.
• - Manage patient cases throughout the insurance review and authorization process.
• - Communicate any adverse determinations to the clinic staff promptly.
• - Create cost estimates for procedures, including both insurance-approved treatments and self-pay.
• - Maintain a log of surgical procedures ordered and those under insurance review.
• - Process incoming and outgoing faxes related to insurance authorizations.
• - Handle incoming and outgoing calls with patients and insurance representatives regarding surgical authorizations.
• - Contact patients to schedule procedures, review cost estimates, and provide pre/post-operative instructions for specific surgical procedures.
• - Communicate with the clinical team regarding questions on benefits, estimates, or authorizations.
• - Provide support and training assistance to team members when needed.

Required Skills / Abilities:

• - Positive and professional demeanor
• - Strong conflict resolution and problem-solving skills
• - Collaborative team player focused on achieving optimal outcomes
• - Excellent verbal and written communication skills across multiple channels
• - Thorough understanding of insurance coverage and policy requirements
• - Self-motivated with the ability to work independently
• - Flexible and adaptable; able to multitask effectively in a fast-paced environment
• - Perform well under pressure and manages time efficiently
• - High attention to detail and accuracy
• - Reliable and dependable work ethic
• - Open to feedback and demonstrates growth from constructive input
• - Proficient in Microsoft Office applications
• - Maintains strict compliance with HIPAA regulations
• - Perform other related duties as assigned.

Education and Experience:

• - High School Diploma or GED required
• - Medical Assistant Certification preferred

*StrideCare is an Equal Opportunity Employer and is committed to diversity and inclusion in our workforce. We encourage applications from candidates of all backgrounds and experiences.

Requirements

Ability to sit for extended periods while working on a computer.

• - Manual dexterity to operate standard office equipment, including computers, phones, and fax machines.
• - Ability to occasionally lift and carry items weighing up to 20 pounds.
• - Sufficient visual acuity to perform tasks involving computer screens and paper documents.
• - Ability to move throughout the office to access files, equipment, and other necessary resources.
• - Home office requirements: Maintain a dedicated workspace that is professional, organized, and free from distractions.
• - Have a reliable high-speed internet connection capable of supporting voice calls, data entry, and system usage without interruption.
• - Ensure workspace security and confidentiality, adhering to company policies on data protection and HIPAA privacy standards.

Notice of AI Use in Job Application Review

As part of our commitment in creating a fair, efficient, and consistent hiring process we may use artificial intelligence (AI) to help our recruiting teams organize, summarize, and analyze information provided by candidates, including resumes, application responses, and other materials submitted during the application process.AI may be used to identify patterns, highlight relevant skills, and experience, and assist in comparing a candidate’s qualifications with the requirement of a specific role. These tools are to improve efficiency and consistency while supporting more informed hiring decisions, which will ultimately be made by the hiring team.