Surgical Prior Authorization Specialist

Pain Institute of Southern Arizona; Tucson (AZ); On-site; USD 42,000 - 54,000; Full time

Job summary

Pain Institute of Southern Arizona is seeking a Surgical Prior Authorization Specialist to obtain pre-authorizations from insurance carriers and input data accurately into the EMR. The role involves coordinating with scheduling staff, patients, and providers to ensure timely approvals and scheduling.

The ideal candidate has at least one year of prior authorization experience in healthcare, strong knowledge of CPT/ICD-10, and proficient use of EMR systems and insurance portals.

Qualifications

• Minimum one-year experience with prior authorization in healthcare.
• Knowledge of CPT, ICD-10, NCCI edits and LCD policies.
• Proficient with EMR systems and insurance portals.
• Excellent verbal and written communication skills.
• Understanding of authorization procedure workflow.
• Understanding of HIPAA regulations and patient confidentiality.

Responsibilities

• Obtain prior authorizations from insurance carriers.
• Input data accurately into the EMR system.
• Review surgical schedules to identify payors needing prior authorization.
• Communicate with scheduling coordinators when authorization is obtained and patient is ready to be scheduled.
• Inform patients and providers about denials and next steps.
• Follow up on all denials and document communications with insurers.
• Perform light administrative duties as assigned.

Skills

Prior authorization experience

Medical terminology

CPT/ICD-10 knowledge

EMR software

Insurance portals

Communication skills

HIPAA compliance

Patient confidentiality

Data analysis

Multitasking

Tools

Excel

EMR software

Job description

The Surgical Prior Authorization Specialist is responsible for obtaining pre-authorizations from insurance carriers. Inputs the data accurately and timely into the EMR software. Review surgical schedules to determine which payors require prior authorization. Review clinical data matching it against specified medical terms and diagnoses or procedure codes and follow established procedure for authorization requests.

Role Overview/ Key Responsibilities

• Ensure accuracy of patient data, demographic and insurance information.
• Communicate with the Surgical Scheduling Coordinator that prior authorization has been obtained and the patient is ready to be scheduled.
• Communicate with patients, providers, and coordinators to inform if their insurance has denied the authorization request.
• Work directly with patients to have them assist with obtaining prior authorization from their insurance carrier when needed.
• Follow-up on all denials.
• Document and track all communication attempts with insurance providers.
• The position will also perform light administrative duties, and any other tasks as assigned.

Required Qualifications

• Minimum one-year experience with prior authorization experience in healthcare.
• Knowledgeable in medical terminology, CPT codes, ICD-10, NCCI edits and LCD policies.
• Computer skills: web browsing, Excel, EMR software and use of insurance portals.
• Excellent verbal and written communication skills.
• Understanding of authorization procedure workflow.
• Understanding of HIPPA regulations.
• Respect for patient confidentiality.

Preferred Skills/Qualifications

• Ability to analyze data to provide appropriate information to insurance companies.
• Ability to respond to questions in a tactful and professional manner.
• Ability to multitask, prioritize tasks, and work efficiently.