Procedure Authorization Specialist

ESSENTIAL FUNCTIONS

• Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
• 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 surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
• Verifies benefits on all surgical procedures.
• Document 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 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 with STAT authorizations.
• Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
• Assists in identifying opportunities for improvement within the daily workflow process.
• Attends department meetings as required.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• A minimum of 2 years of experience in the 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 a strong background in computers and data entry.

KNOWLEDGE

• Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
• Federal, state, and HIPAA privacy regulations.
• Knowledge of computer applications.

SKILLS

• Skill in effective organization and billing requirements and authorization processes.
• Skill in using computer programs and applications including Microsoft Excel, Microsoft Word, and Outlook
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multi-task in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently and demonstrate the ability to analyze data.
• Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching are required.
• Manual dexterity using a calculator and computer keyboard

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision, and Values must be read and signed.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.