Find a Physician
Surgery Authorization RepPrint
Job SummaryProliance Orthopaedics and Sports Medicine, a division of Proliance Surgeons, Inc., currently is seeking a Surgery Authorization Rep.
Job DescriptionPosted: 06/08/2020
Our busy Orthopaedic practice is seeking a motivated self-directed hard working individual to manage all duties relating to authorization for surgeries.
Duties and Responsibilities:
- Reviews and comprehends patient progress notes, lab reports, imaging reports, and plan of care Identifies appropriate medical documentation that satisfies payer medical policy criteria
- Interacts professionally and effectively with clinicians, patients, and insurance companies
- Effectively coordinates Peer to Peer discussions between Clinicians and Insurance companies
- Follows-up with patients in the case of denied coverage of a surgery. Provides superior customer service to all patients, works through patient-raised issues, and recommends appropriate solutions
- Verifies insurance eligibility and benefits, utilizing automated eligibility systems, payer portals, or telephone communication
- Maintains organized, detailed summaries of prior authorization requests to support post-claim denial workflows.
Skills Strongly Preferred
- Effective communication skills
- Ability to work in high volume patient environment
- Strong attention to detail
- Working knowledge of medical terminology, abbreviations and anatomy
- Experience verifying insurance utilizing online portals
- 1 year experience in referral coordination required
- Next Gen AND Epic experience preferred