Surgical Authorization Specialist

Job Description

Job Description

Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

As HOPCo continues to grow, we are looking for a Surgical Authorization Specialist in our Corporate Headquarters.

ESSENTIAL FUNCTIONS

• Monitors the authorizations of upcoming surgical cases, pain procedures and imaging on the physician’s calendars, physician’s templates and CISH Schedule ensuring authorizations are obtained in a timely and accurate manor.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
• Accurately completes cost analysis form, documenting the required cost estimation for collection prior to services.
• Verifies benefits on all surgical procedures, pain procedures and in office procedures
• Document’s authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
• Must be able to communicate effectively with physicians, patients, and co-workers and facilities. Be capable of establishing good working relationships with both internal and external customers.
• Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
• Work with department manager to respond to and reduce complaints timely and professionally.
• Assist surgery schedulers and procedure schedulers with STAT authorizations.
• Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
• Assists in identifying opportunity for improvement within daily work flow process.
• Attends department meetings as required.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred

EXPERIENCE

• Minimum of 2 years’ experience in healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred. Excellent organizational skills and strong customer service orientation are required with strong background with computers and data entry.

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