Surgical Prior Authorization Specialist

OrthoArizona; Peoria (AZ); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

PTO, holidays & sick time

Medical plans

HSA with company contributions

Dental & Vision

401(k)

Pet Discount Plan

ID Theft Protection

Job summary

OrthoArizona is seeking an experienced Prior Authorization Specialist to verify insurance requirements for services, ensure medical necessity, and submit accurate authorizations with CPT/diagnosis codes. You will enter data into EMR, track authorization statuses, and maintain records across systems, while upholding SOPs and delivering patient-centered service.

The role requires 2+ years in healthcare administration, strong terminology knowledge, and excellent communication.

Qualifications

• Excellent customer/patient service.
• Knowledge of medical terminology.
• Excellent written and verbal communication skills.
• Understand/train on practice management software.
• Promote favorable facility image with physicians, patients, insurance companies, and general public.
• Communicate effectively on the telephone.
• Make decisions and solve problems.
• Understand 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.

Responsibilities

• Verify insurance authorization requirements for ordered services/procedures.
• Review documentation or contact the provider to prove medical necessity.
• Submit authorizations with correct CPT and diagnosis codes.
• Cross-reference procedures with doctor's orders for correct submissions.
• Enter authorization numbers and expiration dates into the EMR.
• Update insurance notes in multiple EMR systems.
• Monitor and resolve the status of problem authorizations.
• Fax imaging orders to facilities and ensure patient scheduling.
• Maintain medical records per practice policies.

Skills

Customer service

Medical terminology

Communication skills

Practice management software

Problem solving

Insurance knowledge

Telephone communication

SOP adherence

Teamwork

Independent work

EMR/records entry

Attention to detail

Education

High School diploma or GED

Tools

Practice management software

EMR systems

Job description

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.
• Dental & Vision Insurance.
• 401(k)
• Pet Discount Plan.
• ID Theft Protection & Legal Assistance.