Surgical Prior Authorization Specialist

OrthoArizona; Chandler (AZ); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Paid time off

Medical with plan options

Health Savings Account

Job summary

OrthoArizona is seeking a Surgical Prior Authorization Specialist in Chandler, AZ to verify insurance requirements, review medical documentation, and submit accurate authorizations. You will manage EMR notes, communicate with providers, and support efficient claim processing.

This role requires healthcare admin experience, strong customer service, and knowledge of practice management software. Join a leading orthopedic practice with comprehensive benefits and a collaborative team environment.

Qualifications

• Excellent customer / patient service.
• Knowledge of medical terminology.
• Excellent written and verbal communication skills.
• Understand/Perform training on practice management software.
• Ability to promote favorable facility image with physicians, patients, insurance companies, and general public.
• Ability to communicate effectively on the telephone.
• Follow all Standard Operating Procedures.
• Minimum of 2 years of healthcare administration experience.

Responsibilities

• Verify insurance authorization requirements for ordered services/ procedures.
• Review documentation or contacts the provider when necessary to supplement the order to prove medical necessity.
• Ensure appropriate documentation is available and complete before submitting the authorization to the insurance company to avoid repetitious submissions and denials.
• Submit all authorizations with correct CPT and diagnosis codes.
• Cross-reference the procedure against the doctor’s orders to ensure all services are submitted correctly.
• Enter any authorization numbers and expiration dates into the EMR for proper claim processing.
• Update pertinent insurance notes in multiple EMR systems for corresponding departments to access.
• Monitor and resolve the status of problem authorizations.
• Fax outgoing imaging orders to corresponding facilities and follow the order to ensure the patient is scheduled.
• Maintain medical records in accordance with practice policies and procedures.
• Estimate prepay amounts due for services and collect co-insurance, copays, deductibles or estimates self-pay rates; prepare daily batch, deposits, etc.
• Using state or federally regulated websites may require personal login credentials.

Skills

Customer service

Medical terminology

Communication skills

Health insurance knowledge

Teamwork

Problem solving

Education

High School diploma or GED

Tools

Practice management software

Job description

Anticipate patient needs, exceed expectations, and create lifelong memories.

An orthopedic practice that is made up of over 70 premier specialists, specializing in sports medicine, joint replacement, arthroscopy, fractures, arthritis, and general orthopedic conditions in adult and pediatric patients. OrthoArizona offers a wide variety of services that include advanced imaging, physical therapy, diagnostic testing, casting, durable medical equipment, and workers’ compensation.

We are looking for employees who want to work for a fast-growing organization with a strong reputation for providing comprehensive, high-quality musculoskeletal care. We need professionals who share our vision and the commitment to see it through.

General Employee Benefits

We are committed to providing the best benefits options to our employees so we can support their health, wellness, and happiness.

Basic Life Insurance

Employee Assistance Program

Voluntary Short- & Long-Term Disability

401(k) Plan

Paid Time Off

Position:Surgical Prior Authorization Specialist

Location: Chandler (Southeast Hub), AZ

Job Id:4138

# of Openings:1

Surgical Prior Authorization Specialist

About OrthoArizona

At OrthoArizona, we are bringing the best together. Our organization was created to help serve ALL orthopedic and podiatry needs throughout the Valley! We have a wide range of orthopedic surgeons and mid-level providers including physical and occupational therapists.

Today we are one of Arizona’s largest privately owned and most comprehensive orthopedic practices with more than 75 locally and nationally renowned providers across 30 locations, in addition to 2 ambulatory surgical centers and in house state of the art MRI capabilities. At OrthoArizona we are committed to best-in-class patient care, being a pioneer in research and technology, and most importantly, rewarding and recognizing our employees.

As an Prior Authorization Specialist with OrthoArizona, you will get to:

• Verify insurance authorization requirements for ordered services/ procedures.
• Reviews documentation or contacts the provider when necessary to supplement the order to prove medical necessity.
• Ensures appropriate documentation is available and complete before submitting the authorization to the insurance company to avoid repetitious submissions and denials.
• Submits all authorizations with correct CPT and diagnosis codes.
• Cross-references the procedure tasked against the doctor’s orders to ensure all services are submitted correctly.
• Enters any authorization numbers and expiration dates into the EMR for proper claim processing.
• Update pertinent insurance notes in multiple EMR systems for corresponding departments to access.
• Monitors and resolves the status of problem authorizations.
• Faxes outgoing imaging orders to corresponding facilities and follows the order to ensure the patient is scheduled.
• Maintain medical records in accordance with practice policies and procedures.
• Estimates prepay amounts due for services and collects co-insurance, copays, deductibles or estimates self-pay rates; prepares daily batch, deposits, etc.
• *Using state or federally regulated websites may require personal login credentials.

Qualifications

• Excellent customer / patient service. Knowledge of medical terminology.
• Working knowledge of computer programs.
• Excellent written and verbal communication skills.
• Understand/Perform training on practice management software.
• Ability to promote favorable facility image with physicians, patients, insurance companies, and general public.
• Ability to communicate effectively on the telephone.
• Ability to make decisions and solve problems.
• Working knowledge of health insurance plans including reading plan requirements.
• Follow all Standard Operating Procedures.
• High School diploma or GED.
• Minimum of 2 years of experience in healthcare administration or related field.
• Strong organizational and communication skills.
• Ability to work independently and as part of a team.
• Knowledge of medical terminology and insurance authorization processes.

Full Time Benefits

• Robust paid time off package including, sick time, holidays, & paid time off!
• Medical with multiple different plan options.
• Health Savings account + company contributions.