Pre-Authorization Specialist

• Review and evaluate preauthorization requests for orthopaedic procedures and treatments, ensuring completeness and accuracy of documentation.
• Verify patient insurance coverage and eligibility for requested services.
• Collaborate with healthcare providers to gather necessary medical records and supporting documentation.
• Communicate with insurance companies to obtain preauthorization approvals or address any additional information or documentation requirements.
• Maintain accurate and up-to-date records of preauthorization requests, approvals, and denials.
• 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 orthopaedic preauthorization.

Qualifications:

• Prior experience in orthopaedic preauthorization or medical insurance verification preferred.
• Strong knowledge of orthopaedic procedures, treatments, and medical terminology.
• Familiarity with insurance coding systems (e.g., CPT, ICD-10) and insurance claim processes.
• Excellent 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 and preauthorization software.
• 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.