RCM Authorizations Representative

Who we are: 

Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most – patient care. Headquartered in Stamford, Connecticut, the Spire network spans the Northeast with more than 165 physicians, 1,800 employees, 285 other clinical providers and 40 locations in New York, Connecticut, Rhode Island and Massachusetts.

What you’ll do: 

Responsibilities/Duties:

• Review the EHR task lists for the following services/tests to determine authorization requirements:
  • Commercial Surgery
  • Physical Therapy
  • MRI/CT Scans
  • Injections/VISCO
  • DME/Bone Stimulators
• Review all orders and necessary dictations in EHR regarding request.
• Keep each list updated to ensure timely requests are sent.
• Document all correspondence/updates on each order with the status as it becomes available.
• Notify providers and arrange Peer to Peer requests and follow up on outcome.
• Notify Clinical and Radiology staff of any changes with authorization requirements.
• Act as the direct point of contact for outsourced authorization companies to ensure appropriate turnaround times are being supported per contract.
• Communicate scheduling needs with the Dir. Of Operations, Office Managers and PCC’s.
• Act as a resource for the team, be the first line response to procedural and workflow issues and keep the staff informed of procedure and workflow changes.
• Maintain auth team task list.
• Maintain a professional work atmosphere through behavior and communication with patients, physicians, coworkers and administration.
• Works directly with RCM and Operational Teams to ensure proper scheduling and patient care. Includes monitoring team communication and decision making. 
• Creates, updates, and accesses confidential patients’ data in EMR with high level of confidentiality and accuracy.
• Main contact for all Provider correspondence and patient issues. 
• Demonstrate the ability to prioritize and multi-task.

Who you are:

Qualifications:

• Minimum of one-year prior authorization experience required.
• Knowledge of Orthopedic procedures help, but not essential.
• Excellent telephone etiquette and good communication skills (written and oral).
• Computer literacy skills preferred, including practice management software, EMR, Microsoft Word and Excel.
• Detail oriented and strong organizational skills preferred.
• High school diploma or equivalent.
• Familiar with Local Coverage Insurance Plans

What we offer:

• Excellent growth and advancement opportunities 
• Dynamic environment 
• Access to a diverse network of practitioners 
• Broad infrastructure of tools and programs to enhance employee experience    
• Competitive Compensation 
• Generous PTO  
• Benefits package: health, dental, vision, 401(k), etc. 

We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).  
 

Salary : $22 - $33