Job title: Pre-Authorization Specialist Department: Preauthorization Department Direct Report: Tanya Hough Location: All (Fwb/Cvw/Dst) Job Summary: We are seeking a highly motivated and detail-oriented individual to join our dynamic healthcare team as an Orthopedic/Spine Preauthorization Specialist. In this position, you will play a crucial role in ensuring exceptional patient care, and efficient reimbursement within our Preauthorization Department. You will be responsible for reviewing and processing preauthorization requests for Orthopedic, Imaging, Surgery, Pain Management, and Spine procedures as well as Durable Medical Equipment, and PT while working closely with our surgery schedulers, healthcare providers, insurance companies, and patients to ensure timely approvals. Key Responsibilities: - Review and evaluate preauthorization requests for orthopedic procedures and treatments, ensuring completeness and accuracy of documentation.
- Verify patient insurance coverage and eligibility for requested services.
- Collaborate with clinical staff to gather necessary medical records and supporting documentation.
- Communicate effectively with insurance companies to obtain preauthorization approvals
- Maintain accurate and up-to-date records of preauthorization requests, approvals, and denials status.
- Educate healthcare providers on preauthorization requirements and assist in resolving any preauthorization related issues or concerns.
- Stay updated on insurance industry regulations, policies, and guidelines related to orthopedic preauthorization.
Required Skills & Qualifications: - 1+ years’ experience in prior authorizations, insurance verification, utilization review, or medical billing — experience in orthopedics, spine, or pain management preferred.
- High school diploma or GED required; healthcare-related certificate or associate degree preferred.
- Strong knowledge of orthopedic procedures, treatments, and medical terminology.
- Familiarity with payer portals, EMRs (e.g., Athena, Availity Humana Military, etc), and CPT/ICD-10 basics
- Attention to detail and ability to analyze complex medical documentation.
- Strong communication skills, both written and verbal, with the ability to effectively interact with healthcare professionals, insurance companies, and patients.
- Proficient computer skills, including experience with electronic medical record (EMR) systems
- Ability to work independently and as part of a team, managing multiple priorities and meeting deadlines in a fast-paced environment.
- Commitment to maintaining patient confidentiality and adhering to HIPAA guidelines.
- Professional phone etiquette and ability to work under deadlines.
- Bilingual skills a plus (Spanish/ASL).
What We Offer: - Competitive salary (DOE)
- Medical, dental, and vision benefits
- Paid time off and holiday pay
- 401(k) or retirement plan options
- Supportive team environment and opportunities for growth
How to Apply: Send your resume and brief cover letter to t.hough@orthoassociates.net with the subject line “Preauthorization Specialist — [Your Name]”. Equal Opportunity Employer.
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