Job Description
Job Title: Surgery Prior Authorization Specialist
Location: Atlanta/Sandy Springs, GA
Job Type: Full-Time
About Us:
We are a leading Pediatric Ears, Nose, & Throat practice in Atlanta dedicated to providing exceptional care to our patients. We are currently seeking a skilled and detail-oriented individual to join our team as a Surgery Prior Authorization Specialist.
Job Summary:
The Surgery Prior Authorization Specialist is responsible for managing the prior authorization process for upcoming surgical cases. This role involves ensuring that all authorizations are obtained accurately and in a timely manner, while coordinating closely with physicians, surgical centers, and insurance companies. The ideal candidate will have a strong background in prior authorizations and insurance verification, with a focus on surgery, and will be capable of working in a fast-paced, pediatric ENT setting.
Minimum Qualifications:
- Minimum one year of experience in prior authorization and insurance verification.
- Prior experience in Ears, Nose & Throat (ENT) is highly preferred.
- Familiarity with EMR systems: EPIC and/or ModMed, is highly preferred.
- Familiarity with insurance processes and authorizations.
Essential Functions:
- Monitor and manage authorizations for upcoming surgical cases, ensuring timely and accurate approval.
- Verify patient demographic information and insurance eligibility, including coordination of benefits.
- Complete surgical cost analysis forms and provide cost estimates for patient collections prior to surgery.
- Verify insurance benefits for all surgical procedures.
- Document authorizations and update patient records with authorization progress.
- Enter authorization information into the case management system.
- Communicate effectively with physicians, patients, coworkers, hospitals, and surgical centers.
- Provide ongoing training to staff on new processes to ensure timely surgical case confirmations.
- Assist surgery schedulers with urgent (STAT) authorizations.
- Maintain confidentiality of health records and patient information in compliance with HIPAA guidelines.
- Identify workflow improvement opportunities and work with the department manager to resolve any complaints professionally and promptly.
- Attend department meetings as required.
Skills and Abilities:
- Strong communication and interpersonal skills.
- Detail-oriented with excellent organizational abilities.
- Ability to work both independently and collaboratively.
- Proficiency with case management software and insurance verification tools.
- Familiarity with HIPAA compliance and confidentiality standards.
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