Surgical Authorization Specialist

Healthcare Outcomes Performance Co. (HOPCo); Phoenix (AZ); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Monthly $43 stipend toward ancillary/4

HSA with company match

401k with company match (Part-time)**

EAP 24/7

Wellness events

Competitive health & welfare benefits

Job summary

Healthcare Outcomes Performance Co. (HOPCo) seeks an experienced healthcare support specialist to coordinate surgical authorizations, verify eligibility, and manage cost estimation prior to services.

The role emphasizes accuracy, confidentiality, and timely communication with physicians and patients. You will work with front-office staff, schedulers, and care teams to ensure smooth pre-authorization workflows, handling multiple payer rules and documenting progress in the patient chart.

Qualifications

• Minimum of 2 years of experience in the healthcare field.
• Experience in referrals/authorizations, front office, and/or charge posting preferred.
• Strong organizational skills and customer service orientation with computer/data entry proficiency.
• Working knowledge of eligibility, verification of benefits, and prior authorizations from HMOs, PPOs, and other payers.

Responsibilities

• Monitor upcoming surgical case authorizations to ensure timely approvals.
• Verify patient demographics, insurance eligibility, and coordination of benefits.
• Complete surgical cost estimation forms for pre-service collection.
• Verify benefits for all surgical procedures and document authorizations in the chart.
• Communicate effectively with physicians, patients, and staff to maintain strong working relationships.
• Assist in staff training on new processes to improve workflow and reduce complaints.
• Support surgery schedulers with STAT authorizations.
• Maintain HIPAA confidentiality throughout all processes.

Skills

Customer service

Organizational skills

Data entry

Attention to detail

Job description

• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Wellness Events

Benefits

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Wellness Events

Minimum Qualifications

• A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
• Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
• Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.

Essential Functions

• Monitors the authorizations of upcoming surgical cases on the physician's calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
• completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
• Verifies benefits on all surgical procedures.
• Document authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
• Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
• Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
• Work with the department manager to respond to and reduce complaints timely and professional.
• Assist surgery schedulers with STAT authorizations.
• Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
• Assists in identifying opportunities for improvement within the daily workflow process.
• Attends department meetings as required.