Prior Authorization Specialist Surgery Jobs at Oregon Urology Institute
Sample Prior Authorization Specialist Surgery Job Description
Prior Authorization Specialist - Surgery
Oregon Urology Institute has an opening for a full time Prior Authorization Specialist (Surgery)
Position Overview
Responsible to obtain all required authorizations prior to a surgery or other OUI service being performed, includes verification of patient insurance coverage, benefit levels, out of pocket responsibilities and correcting denied claims
Essential Job Functions
- Verify insurance coverage for scheduled surgery patients
- Verify coverage levels for each specific patient surgery
- Review all scheduled surgeries for needed authorizations
- Contact insurance carriers to obtain necessary surgery authorizations prior to surgery
- Notify patients of deposit requirements and follow-up as necessary
- Work closely with surgery schedulers, coders and clinical staff to ensure authorizations are obtained for all surgeries
- Work closely with other members of the Authorization/Referral team to ensure Office visit authorizations are in place prior to Surgery
- Review and take corrective action on denied claims
- Responsible to ensure that reimbursement exceeds cost of supplies (implants, etc.) for all surgeries and/or procedures done within OUI and OSC
- Obtain Authorization for outside test or procedures as needed
- Perform other duties as assigned by Department Lead or Manager
Requirements
- Prior experience working in a related role in a medical office or other health care related organization
- Knowledge of CPT and ICD10 coding
- Knowledge of insurance coverages and reimbursement practices
- Strong verbal and written communication skills
- Strong computer skills
- Ability to work both independently and as a member of a team
- Ability to remain organized and detail oriented while working at a fast pace
Miscellaneous
- Candidate must pass a drug screen and background check to obtain employment
- Covid vaccination required
Competitive benefit package.
All interested applicants will need to complete our online employment application.
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