Surgery Authorizations

Position Summary: The Surgery Insurance Verification/Authorization Specialist is responsible for the insurance verification and obtaining authorizations on all insurance plans for all In-Office, ASC, and Outpatient Surgeries.  Insurance benefits  are verified utilizing on-line insurance website resources or research which may require outbound phone calls to insurance companies. Once the insurance has been confirmed active, benefits are documented in the EMR.   Authorization is requested utilizing online insurance portals, submission of authorization request forms, and faxing requests to primary care providers.  Once authorization is obtained it is entered into the EMR system. This position works very closely with the surgery schedulers and the ordering providers to ensure there are no delays for scheduled surgeries.

Reports to:  CBO Director

Flexibility:  While this job description is meant to provide an overview and specific responsibilities of the Surgery Insurance Verification and Authorization Specialist, ENTA Management reserves the right to make changes, adjustments, and revisions, as needed, to this document and will coordinate such modifications with ENTA’s Practice Administrator and Physicians. While the normal work week is 40 hours, you may be subject to overtime (not to exceed 50 hours per week). 

Summary of General Duties:

• Contact various insurance companies either by phone or on-line website sites to obtain insurance benefits and authorizations.
• Contact patient or PCP to obtain information necessary to verify insurance.
• Verify insurance is accurate, updated and active.
• Verify insurance eligibility and benefits for copay, deductible and coinsurance.
• Obtains pre-certification/pre-authorization from insurance companies.
• Confirm insurances are in-network.  If not, notify the surgery scheduler.
• Fax authorization requests to primary care and insurance companies through Provider Flow.
• Maintain updated knowledge of payor policies and guidelines for surgical procedures.
• Scan and enter authorizations and referral into EMR.
• Link Authorization to the surgery appointment in EMR.
• Document accounts in the EMR on surgery orders note task and in appointment comments.
• Add updated insurance to EMR.
• Update PCP and demographics in EMR.
• Scan documents into EMR.
• Import Faxes from Provider Flow to EMR.
• Research enrollment issues due to lack of information or incorrect information.
• Complete all tasks within the timelines established by the practice.
• Answer the telephone in a warm, friendly manner. 
• Maintains patient confidentiality.
• Perform other duties as assigned or requested.
• Follow the release of information protocol established by ENTA that follows the HIPAA guidelines to release medical records.
• Maintain Professional and timely communications with surgery schedulers and physicians.

Working Environment:

• Physical demands:  
  • Average percent of time during regular shift devote to:
    • Walking, Squatting, Sitting, Bending, Reaching:       75%
    • Standing:                                                                     25%
  • Average lifting requirements:
    • Lifting Requirements:           20-40 lbs.
    • Frequency of Lifting:              0-25% of the time
  • Additional physical demands:
    • Ability to grasp with both hands; pinch with thumb or forefinger; turn with hand/arm; reach for (above shoulder height).
    • Ability to type 60 wpm.
    • Ability to operate multi-line telephone system, computer keyboard and ten-key adding machine.

• Visual, Hearing, and Mental demands:  Vision adequate to perform essential functions such as read telephone displays/computer terminals for long periods of time, correctable to 20/20. Hearing is adequate to perform essential functions such as answering the telephone. Mental capacity adequate to perform essential functions such as quickly and accurately entering patient demographics and scanning documents while checking in multiple patients.  Tact to deal with unfriendly individuals regarding various situations, and adequately handle stress.

Working Conditions: This position has an option to work from home after training has been completed. Performance, reliability, and overall fit for the role will be assessed prior to an employee being given permission to work remotely and will continue to be assessed once the employee has gone remote.  Required to exhibit a positive attitude and a professional appearance and show detail and accuracy. Required to exhibit quality performance of the essential job functions to help the practice run effectively and efficiently

Position Requirements:

• High School education or GED equivalent. 

• Minimum one year of medical office experience preferred.
• Working knowledge of insurance verification process and contracted insurance plans.
• Good verbal and written communication skills.
• Excellent telephone and customer service skills.
• Demonstrated ability to use a computer with Microsoft Word, Outlook and EMR software.
• Strong organizational skills with the ability to multi-task.
• The ability to attend work on a regular basis.
• The ability to adhere to safety rules and other reasonable regulations pertaining to the job.
• The ability to refrain from negativity or excessive irritability.
• The ability to work in cooperation with other workers.
• Ability to maintain confidentiality and thorough knowledge of HIPAA policies and procedures.