Precertification Coordinator Jobs in Decatur, GA

  The Surgical Services Coordinator manages the end to end process that moves a patient from a provider's procedure order to a confirmed, authorized, and financially cleared date on the surgery schedule. The position schedules procedures at the ambulatory surgery center, obtains insurance precertification and prior authorization, calculates and collects deposits for both physician and facility fees, and serves as the patient's point of contact for scheduling and financial questions. The role acts as the liaison between patients, providers, insurance carriers, the ASC, and outside facilities to protect on time starts, clean claims, and an accurate patient financial experience.
 

• Schedule procedures at the ambulatory surgery center and coordinate dates with the provider, the patient, and facility staff.
• Review provider orders and scheduling requests for completeness and accuracy before the case is placed on the schedule.
• Enter required notation in three places for every case: the order, the appointment note line, and the authorization record in the system.
• Confirm pre-procedure requirements are in place, including medical clearance, imaging, and supporting clinical documentation.
• Communicate schedule changes, add ons, and cancellations to affected providers, clinical staff, and patients.
• Coordinate scheduling for cases performed at outside facilities when applicable.

• Verify insurance eligibility, benefits, and preauthorization requirements for orthopedic, spine, and pain procedures.
• Submit prior authorization requests through payer portals, fax, telephone, or electronic systems.
• Obtain and document authorization numbers, approved CPT codes, effective dates, units, and expiration dates.
• Follow up on pending authorizations on a defined cadence and escalate cases at risk of missing the scheduled date.
• Coordinate peer to peer reviews when requested by the insurance carrier and schedule them with the provider.
• Appeal denied authorization requests and supply supporting clinical documentation.
• Communicate approvals, denials, and pending status to providers, clinical staff, billing, and patients.
• Maintain current knowledge of payer guidelines, medical policy, and conservative care requirements for orthopedic and spine procedures.

• Calculate estimated patient responsibility for both the physician professional fee and the facility fee, using verified benefits and contracted rates.
• Verify deductible, coinsurance, copay, and out of pocket status prior to the procedure date.
• Contact patients before the procedure to review their estimated financial responsibility and payment expectations.
• Collect surgery and procedure deposits in accordance with practice and ASC financial policy.
• Process payments accurately through approved payment systems and issue receipts.
• Establish payment arrangements within the limits set by practice policy and route exceptions to the Director of Practice Operations.
• Provide a Good Faith Estimate to uninsured and self pay patients at scheduling or on request, consistent with No Surprises Act requirements.
• Document every financial conversation, quoted estimate, deposit, and payment arrangement in the patient account.

• Answer patient calls regarding procedures, scheduling, authorization status, and financial questions.
• Explain benefits, coverage limits, and practice financial policy in plain language the patient can act on.
• Update patient accounts and maintain accurate, current documentation in the practice management and EMR systems.
• Keep documentation complete enough that any team member can pick up a case and know exactly where it stands.

The following clinic tasks are currently assigned to this position and are performed in addition to the ASC scope above.

• Check patient balances and follow up on outstanding patient payments.
• Complete medication reports.
• Process medical records requests as provider notes are completed, in accordance with HIPAA release requirements and practice turnaround standards.

• High school diploma or equivalent.
• Working knowledge of medical terminology, orthopedic and spine procedures, and CPT and ICD-10 coding as it applies to authorization.
• Experience with commercial insurance, Medicare, Medicaid, workers compensation, and personal injury payers.
• Proficiency in EMR (Athena Health) and practice management systems.
• Demonstrated accuracy with numbers and the ability to explain a cost estimate to a patient clearly.
• Strong organizational, follow through, and written communication skills.

• Experience in an orthopedic, spine, sports medicine, or surgical specialty practice.
• Prior experience in an ambulatory surgery center setting.
• Experience with surgical scheduling and surgical billing workflows.
• Bilingual English and Spanish.

• Attention to detail and accuracy under deadline.
• Ownership of a case from order to completed procedure without prompting.
• Patient service, including difficult financial conversations handled with respect.
• Critical thinking and problem solving with payers.
• Collaboration with providers, clinical staff, front desk, and revenue cycle.
• Confidentiality and sound judgment with protected health information.

• Authorization turnaround time from order to approval.
• Percentage of cases authorized before the scheduled procedure date.
• Authorization approval rate and appeal success rate.
• Deposit collection rate against estimated patient responsibility.
• Accuracy of patient estimates measured against final patient responsibility.
• Rate of cases rescheduled or cancelled for authorization or financial clearance reasons.
• Documentation completeness and compliance audit results.

This position works in a clinical office and ambulatory surgery center setting. The role requires extended periods of sitting and computer and telephone use, frequent verbal communication, and occasional lifting of up to 20 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. This position description outlines the primary duties and expectations of the role. It is not an exhaustive list, and duties may be modified as the needs of the practice change. This description does not create an employment contract or alter the at will employment relationship.
LOCATION: Remote/Candidate must reside in the State of Georgia.
Why Join Us?
ReVive Orthopedics Spine & Sports Medicine offers a collaborative environment focused on patient care excellence and professional growth. We provide a competitive benefits package, including:

• Medical Insurance
• Vision and Dental Insurance
• 401(k) Retirement Plan
• Paid Time Off and Holidays
• Mileage Reimbursement for travel to satellite offices
• Compensatory Bonuses based on productivity and performance

Join our team and contribute to a positive, patient-centered experience in orthopedic healthcare.
This position description is not intended to be a complete list of all responsibilities, duties, or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of ReVive Orthopedic Spine & Sports Medicine. Since no position description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, duties, and responsibilities that may be inherent in a job, reasonably required for its performance, or required due to the changing nature of the job shall also be considered part of the job holder’s responsibility.

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