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About the Role
The Surgical Authorization Specialist is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to service delivery. This role involves clear communication with payers and clinical partners to ensure compliance and accurate documentation.
Responsibilities
- Verifies insurance eligibility and benefit levels.
- Works with payers via electronic, telephonic, and fax communications.
- Verifies and investigates pre-certification, predetermination, and referral requirements.
- Determines medical necessity by reviewing medical policies.
- Collaborates with clinical contacts regarding encounters requiring peer-to-peer review.
- Communicates with patients, clinical navigators, financial counselors, and others to facilitate authorization.
- Facilitates submission of clean claims and reduction in payer denials.
- Prioritizes workload to ensure timely handling of urgent cases.
- Completes accurate documentation in the electronic medical record.
- Notifies all payers within 24 business hours of service.
- Follows departmental policies for obtaining authorization.
- Answers questions regarding insurance authorization requirements.
- Operates standard office equipment.
- Maintains regular and predictable attendance.
- Adheres to Advanced Pain Care’s Policies and procedures.
- Performs other duties as assigned.
Requirements
- Minimum of three years’ experience in billing/pre-authorization or insurance verification.
- Demonstrated knowledge of health insurance plans including Medicare, Medicaid, HMO’s and PPO’s.
- Must be able to work as scheduled (typically 8:00 AM - 5:00 PM, Monday-Friday).
- Must be able to sit for prolonged periods of time.
Skills
- Clear and effective communication
- Exceptional customer relations
- Knowledge of billing terminology including CPT codes and ICD-10 codes
- Knowledge of online insurance portals
- Excellent typing and computer skills
- Effective time management through organizing and prioritizing
- Tactful principles and practices of dealing with the public
- Safety habits
- Patient information protection and confidentiality
Location
- Austin/surrounding area
- Remote/Hybrid
Work Type
- Remote
- Hybrid
Experience Level
- Minimum of three years’ experience
Education Level
- High school diploma or GED
About the Company
- Advanced Pain Care