Prior Authorizations Specialist

ob Summary

Spine Institute of Central Florida is in search of a Prior Authorizations Specialist for our very busy Orthopaedic Spine Practice.

Job Description

Spine Institute of Central Florida is a busy, fast paced Orthopaedic Spine Surgery practice. We specialize in the entire spectrum of non-surgical and surgical care of the spine. The Surgical Prior Authorizations Specialist will specialize in coordinating surgical prior authorizations for surgical procedures for our practice and ambulatory surgical center for procedures such as orthopaedic spine surgeries, injections, kyphoplasties, and single case agreements with insurance companies based on surgical/procedural needs.

Duties

• Request, review, and process procedural and surgical authorization requests and single case agreements in accordance with insurance guidelines and managed care policies are the main focus of this role.
• Use of portals and knowledge of appeals are vital to this role.
• Verify patient insurance coverage and eligibility to ensure proper authorization before procedures are scheduled.
• Collaborate with physicians, surgeons, and administrative staff to gather necessary documentation for authorization submissions.
• Utilize CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems to accurately document procedures and diagnoses.
• Maintain detailed medical records related to authorization requests, ensuring compliance with HIPAA regulations.
• Follow up with insurance companies to track approval statuses and resolve any discrepancies or denials promptly.
• Ensure all documentation is complete, accurate, and submitted within required timeframes to prevent delays in patient care.
• Stay informed about changes in managed care policies, coding updates, and healthcare regulations affecting surgical authorizations.

Requirements

• Proven experience in medical office settings, preferably within surgical, ambulatory surgical centers, or specialty clinics.
• Strong knowledge of managed care processes, insurance verification, and prior authorization procedures.
• Familiarity with medical terminology, medical records management, and medical coding including CPT, ICD-9, ICD-10 codes.
• Experience working with HIPAA regulations to safeguard patient confidentiality.
• Excellent organizational skills with the ability to manage multiple cases efficiently under tight deadlines.
• Office experience in a healthcare environment is essential; dental office experience is a plus.
• Proficiency with electronic health records (EHR) systems and insurance claim platforms.
• Effective communication skills for liaising between healthcare providers, insurance companies, and patients.
• Join our team as a Prior Authorizations Specialist to play a vital role in streamlining surgical approvals while ensuring compliance and delivering exceptional support for patient care initiatives!

Seeking candidates who share our mission, vision, and core values in providing the absolute best patient care experience.

• Competitive salary
• Comprehensive training
• IRA with employer match
• Health, Vision, Dental insurance
• Paid time off
• Ability to make an impact in the communities we serve