Surgical Prior Authorization Specialist

OrthoArizona; Peoria (AZ); Sur place; USD 42 000 - 60 000; Plein temps

Avantages offerts par ce poste

Robust paid time off

Medical insurance

Health Savings Account

Résumé du poste

OrthoArizona is seeking a Surgical Prior Authorization Specialist in Peoria, AZ. The role focuses on verifying insurance authorization requirements, ensuring documentation supports medical necessity, and submitting authorizations with correct CPT and diagnosis codes.

You will enter authorization data into EMR and monitor status to prevent denials. The position requires at least 2 years in healthcare administration, with strong customer service and knowledge of medical terminology.

Qualifications

• Minimum of 2 years of experience in healthcare administration or related field.
• Excellent customer/patient service and knowledge of medical terminology.
• Strong written and verbal communication skills.
• Ability to promote a positive facility image with physicians, patients, and insurers.
• Ability to work with telephone communication and team collaboration.
• Understanding of insurance authorization processes and procedures.
• Follows standard operating procedures.

Responsabilités

• Verify insurance authorization requirements for ordered services/procedures.
• Submit authorizations with correct CPT and diagnosis codes.
• Ensure documentation is complete before submitting to avoid denials.
• Enter authorization numbers and expiration dates into EMR.
• Monitor and resolve status of problem authorizations.
• Maintain medical records per policy.
• Estimate prepay amounts and collect co-insurance, copays, deductibles, or self-pay rates.

Connaissances

Customer service

Medical terminology

Verbal communication

Telephone communication

Organization

Independent/work in team

Insurance authorization processes

Decision making/problem solving

Formation

High School diploma or GED

Outils

EMR systems

Practice management software

Computer programs

Description du poste

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: Peoria (West Admin Hub), AZ

Job Id:4206

# 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.