Prior Authorization & Patient Financial Specialist

Position Overview:

We are a world-renowned gynecologic surgical practice seeking a detail-oriented, patient-focused professional to guide patients through their financial responsibilities prior to surgery.

The ideal candidate is highly organized, thrives in a fast-paced environment, and is comfortable discussing financial matters with patients in a supportive and professional manner.

Key Responsibilities:

• Submit and track prior authorization requests for all patients on the surgical schedule, ensuring approvals are obtained prior to surgery.
• Obtain retroactive authorizations when necessary.
• Prioritize workload based on authorization timelines, payer requirements, and clinical urgency, including urgent (STAT) requests.
• Prepare and present patient cost sheets based on the recommended surgical plan.
• Communicate insurance coverage and financial responsibility clearly, addressing patient questions regarding billing, estimates, and financial assistance.
• Review and verify patient demographics and insurance information for accuracy.
• Document all communication with patients and insurance companies while maintaining accurate, up-to-date records.
• Apply office policies related to deposits, cancellations, and appointment fees when assisting patients.
• Communicate effectively with physicians, patients, coworkers, and hospital contacts.
• Support pre-operative processes by confirming appointments and verifying completion of required surgical paperwork in EMR.
• Update patient accounts when insurance status changes (e.g., Self-Pay vs. Insurance) and ensure all records are updated accordingly.
• Follow up on outstanding or unresolved insurance-related matters.
• Assist with incoming calls when front desk lines are busy and provide cross-coverage as needed.

Professional Requirements:

• Minimum of 2 years of experience in a medical office setting (specialty surgery experience preferred).
• Bilingual (English/Spanish) preferred.
• Strong working knowledge of insurance plans, including commercial and marketplace plans, out-of-network benefits, retroactive authorizations, and basic CPT/ICD-10 coding.
• Ability to clearly explain insurance benefits and coverage details to patients.
• Demonstrated experience with prior authorizations is required.
• Comfortable discussing financial responsibility and surgical costs with patients in a professional and compassionate manner.

Required Skills:

• Proficiency in Microsoft Word, Excel, Outlook, and Adobe; strong general computer skills required.
• Ability to manage a high-volume workload while maintaining strong attention to detail.
• Experience with EHR/Practice Management systems.
• Strong organizational skills with excellent follow-through and time management.
• Exceptional verbal and written communication skills; must be professional, empathetic, and patient-focused.
• High level of integrity with the ability to handle confidential information in compliance with HIPAA regulations.

Compensation & Benefits:

• Employer-paid medical and dental insurance (employee-only; eligible after 3 months).
• 01(k) profit-sharing plan; eligibility after 1 year.
• Generous paid time off (PTO) that increases with tenure.
• Paid holidays.
• Generous annual Christmas bonus.

Work Schedule:

• Monday & Friday: 7:00 AM - 3:30 PM
• Tuesday l Thursday: 9:00 AM - 5:30 PM.
• No weekends required.
• This is an in-office position . Remote work is not available.