Surgery Prior Authorization Specialist
PEDIATRIC EAR NOSE & THROAT OF ATLANTA PCAtlanta, GA • On-site
$17.25 - $23/hr
Full-time
Posted 12 days ago
Job description
Job Title: Surgery Prior Authorization Specialist
Location: Atlanta/Sandy Springs, GA
Job Type: Full-Time
About Us:
We are a leading Pediatric Ears, Nose, & Throat practice in Atlanta dedicated to providing exceptional care to our patients. We are currently seeking a skilled and detail-oriented individual to join our team as a Surgery Prior Authorization Specialist.
Job Summary:
The Surgery Prior Authorization Specialist is responsible for managing the prior authorization process for upcoming surgical cases. This role involves ensuring that all authorizations are obtained accurately and in a timely manner, while coordinating closely with physicians, surgical centers, and insurance companies. The ideal candidate will have a strong background in prior authorizations and insurance verification, with a focus on surgery, and will be capable of working in a fast-paced, pediatric ENT setting.
Minimum Qualifications:
- Minimum one year of experience in prior authorization and insurance verification.
- Prior experience in Ears, Nose & Throat (ENT) is highly preferred.
- Familiarity with EMR systems: EPIC and/or ModMed, is highly preferred.
- Familiarity with insurance processes and authorizations.
Essential Functions:
- Monitor and manage authorizations for upcoming surgical cases, ensuring timely and accurate approval.
- Verify patient demographic information and insurance eligibility, including coordination of benefits.
- Complete surgical cost analysis forms and provide cost estimates for patient collections prior to surgery.
- Verify insurance benefits for all surgical procedures.
- Document authorizations and update patient records with authorization progress.
- Enter authorization information into the case management system.
- Communicate effectively with physicians, patients, coworkers, hospitals, and surgical centers.
- Provide ongoing training to staff on new processes to ensure timely surgical case confirmations.
- Assist surgery schedulers with urgent (STAT) authorizations.
- Maintain confidentiality of health records and patient information in compliance with HIPAA guidelines.
- Identify workflow improvement opportunities and work with the department manager to resolve any complaints professionally and promptly.
- Attend department meetings as required.
Skills and Abilities:
- Strong communication and interpersonal skills.
- Detail-oriented with excellent organizational abilities.
- Ability to work both independently and collaboratively.
- Proficiency with case management software and insurance verification tools.
- Familiarity with HIPAA compliance and confidentiality standards.
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Frequently asked questions
Q: What skills or qualities help someone succeed as a Authorization Specialist?
A: To succeed as an Authorization Specialist, key technical skills include proficiency in access control systems, familiarity with regulatory compliance frameworks (e.g., GDPR, HIPAA), and expertise in identity and access management (IAM) tools. Soft skills such as strong analytical and problem-solving abilities, effective communication, and attention to detail are also crucial for navigating complex authorization processes and ensuring seamless integration with organizational policies. By combining these technical and soft skills, Authorization Specialists can effectively manage access, mitigate risk, and drive business growth, ultimately supporting their career advancement and professional development.
Q: What is the career path for a Authorization Specialist?
A: A typical career progression for an Authorization Specialist involves starting as an Entry-Level Authorization Specialist, where they review and process authorization requests, and then advancing to a Mid-Level Authorization Specialist, where they analyze complex authorization requirements and develop policies. As they gain experience, they can move into Senior Authorization Specialist roles, overseeing teams and implementing strategic authorization initiatives. Key opportunities for skill development include learning about regulatory compliance, risk management, and data analysis, which can lead to long-term career prospects in leadership, compliance, or specialized roles such as Information Security Specialist or Business Analyst.
