Surgery Prior Authorization Specialist

Job Description

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.