SUMMARY DESCRIPTION

The Surgery Scheduling Pre-authorization position is responsible for obtaining pre-authorizations for scheduled surgery cases

RESPONSIBILITIES

• Works closely with the surgery schedulers to obtain authorizations for all scheduled surgical cases at all facilities. This will include pulling the appropriate documentation to support the scheduled procedure, faxing, calling or using the insurance company portal to obtain authorization. If the insurance company recommends a pre-determination, follow the appropriate steps to obtain a pre-determination. 
• If the pre-auth request is denied, follow the appropriate steps to complete an appeal or set up a Peer 2 Peer call.
• Verify eligibility for all upcoming cases, paying attention if “other” insurance is listed on the eligibility response, fixing any issues that are discovered, which may include ID numbers, wrong insurance entered, dob.
• This role is pertinent to the practice to be sure all avenues to secure payment from the insurance company have taken place, which includes details itemized above and any other unforeseen issue that may arise during the pre-auth, pre-determination or eligibility verification process.
• Provides necessary/pertinent documentation to the insurance companies.
• Work with the surgery schedulers to clarify any questions. If further clarification is needed from the physician to obtain an authorization, it will be necessary to reach out to the physician.
• Maintains an open line of communication with the Director of Revenue Cycle Management and co-workers.
• Attends department and company staff meetings.
• All other duties as assigned.

QUALIFICATIONS

• High school graduate.
• Minimum of one year work experience pre-authorizations or similar role
• Medical terminology, CPT and ICD-10 coding experience preferred.
• A team player who works well under pressure and who can communicate clearly in person and/or on the phone.
• Knowledge of basic insurance guidelines 
• Ability to organize and prioritize tasks effectively
• Experience with a practice management system and EMR, preferable Allscripts

ENVIRONMENTAL/WORKING CONDITIONS

• Medical office setting.
• Well-lit and well-ventilated adequate space.
• Some exposure to communicable diseases and/or other conditions common to clinic setting.

PHYSICAL/MENTAL DEMANDS

• Requires sitting for extensive periods of time. 
• Must be able to view a computer screen for an extended period.
• Light lifting required up to 15 lbs.
• Requires manual dexterity sufficient to operate a keyboard, operate a calculator, telephone, copier, and such other equipment, as necessary.