Surgical Authorization Specialist - Hybrid - Remote

Overview

The Surgical Authorization Specialist is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification and authorization requirements are met prior to the delivery of outpatient and ancillary services.

In Short

• Verifies insurance eligibility and benefit levels.
• Works with payers via electronic/telephonic communications.
• Responsible for pre-certification and referral requirements.
• Determines medical necessity by reviewing medical policies.
• Communicates with patients and clinical navigators.
• Facilitates submission of clean claims to reduce payer denials.
• Prioritizes workload to handle urgent cases timely.
• Completes accurate documentation in electronic medical records.
• Answers questions surrounding insurance authorization requirements.
• Operates standard office equipment.

Requirements

• High school diploma or GED required.
• Minimum of three years’ experience in billing/pre-authorization.
• Knowledge of health insurance plans including Medicare and Medicaid.
• Clear and effective communication skills.
• Exceptional customer relations skills.
• Knowledge of billing terminology including CPT and ICD-10 codes.
• Excellent typing and computer skills.
• Ability to manage and prioritize tasks effectively.
• Practices safety habits and maintains confidentiality.

Benefits

• Remote work option after training.
• Opportunity to work in a medical office environment.
• Regular and predictable attendance required.