surgical scheduling, financial

Position Title: Surgical Scheduling, Financial & Medical Clearance Specialist.

Department: Surgical Services

Supervisor's Title: Surgical Services Manager

I. Position Summary

The Surgical Scheduling, Financial & Medical Clearance Specialist is a key clinical operations role responsible for coordinating surgical access, patient readiness, and financial clearance for all scheduled surgical procedures. This position serves as the central point of accountability for aligning clinical requirements, patient communication, insurance authorization, and billing accuracy to ensure safe, efficient, and compliant surgical care delivery.

This role requires advanced knowledge of perioperative workflows, medical terminology, procedural coding, and insurance authorization processes to support optimal operating room utilization, patient experience, and revenue integrity. While a Medical Assistant credential is required to support clinical understanding, this position functions at a higher level of responsibility than a traditional MA role and does not provide routine clinical care.

II. Principal Functions and Responsibilities

A. Clinical Coordination & Surgical Readiness

• Serves as the central coordination point for surgical scheduling, ensuring procedures are clinically appropriate, accurately scheduled, and operationally feasible.
• Applies clinical knowledge and judgment to assess scheduling requests, identify conflicts, and coordinate required resources across Surgical Services, anesthesia, nursing, clinics, and ancillary departments.
• Consults with anesthesia and clinical teams regarding patient conditions, procedural requirements, and special considerations prior to finalizing the surgical schedule.
• Coordinates pre-operative requirements including surgical clearances, diagnostic testing, medication holds, and specialty consults.
• Communicates procedural expectations, timelines, and pre- and post-operative instructions to patients to support preparedness and continuity of care.
• Ensures post-operative appointments and follow-up care are coordinated with clinic scheduling staff.
• Maintains, monitors, and distributes the daily surgical schedule and promptly communicates changes to all impacted departments.
• Proactively identifies and addresses open surgical time, cancellations, and schedule changes to support optimal operating room utilization and patient access.
• Supports patient education initiatives, including teaching total joint classes as assigned.

B. Revenue Integrity, Authorization & Financial Clearance

• Reviews and validates procedural codes, modifiers, and related clinical information at the time of scheduling to support accurate billing, authorization, and charge capture.
• Ensures procedural coding aligns with clinical documentation and scheduled services prior to submission for prior authorization.
• Confirms that required prior authorizations and referrals are obtained using validated codes before procedures are finalized.
• Coordinates with physician offices, clinical staff, anesthesia, and revenue cycle teams to resolve coding, authorization, or coverage discrepancies prior to the date of service.
• Verifies patient demographic and insurance information to ensure consistency across scheduling, authorization, billing, and patient financial records.
• Provides Good Faith Estimates using verified procedural codes and insurance information in compliance with regulatory requirements.
• Identifies and escalates potential authorization, coding, or coverage issues early to prevent denials, delays, or financial risk to the organization.
• Participates in reconciliation of surgical charges and collaborates with leadership and revenue cycle teams to resolve discrepancies.

C. Operational & Administrative Support

• Utilizes Cerner EHR and scheduling systems to maintain accurate, compliant, and up-to-date surgical schedules.
• Maintains required documentation in accordance with HIPAA, CMS, DNV, and organizational policies.
• Cross-trains within the department to ensure continuity of surgical scheduling and patient access operations.
• Answers phones professionally and courteously and serves as a knowledgeable resource for patients, providers, and staff.
• Performs other duties as assigned in support of Surgical Services operations.

III. Position Qualifications / Requirements

Minimum Qualifications – Experience

• Minimum of two (2) years of experience as a Medical Assistant to support clinical knowledge, medical terminology, and understanding of procedural workflows.
• At least one (1) year of progressive responsibility in healthcare scheduling, patient access, revenue cycle support, or clinical coordination, including involvement in scheduling procedures, managing authorizations, coordinating care, or communicating with patients and providers.

Previous experience in surgical or procedural scheduling within a healthcare environment required.

Advanced knowledge of medical terminology, surgical procedures, insurance authorization processes, and healthcare billing workflows.

Working knowledge of CPT/HCPCS coding and modifier application as it relates to surgical scheduling, authorization, and billing.

Demonstrated ability to coordinate complex, multi-departmental workflows while managing competing priorities.

High level of attention to detail with accountability for accuracy impacting patient care, compliance, and revenue.

Strong verbal and written communication skills with the ability to interact professionally with patients, physicians, and interdisciplinary teams.

Proficiency with EHR systems (Cerner preferred) and standard business software including Excel and Word.

Knowledge of HIPAA and confidentiality requirements.

Customer service experience in a healthcare setting strongly preferred.