Surgical and Medical Authorization Specialist

Description

The Surgical and Medical Authorization Specialist is responsible for managing and processing all authorization requests for surgical procedures, Durable Medical Equipment (DME), Gel and Xiaflex injections, and STAT MRI procedures. This role involves working closely with medical providers, insurance companies, and patients to ensure timely and accurate approval for services rendered by the practice's surgeons. The specialist will ensure that all authorization requirements are met, accurately document all correspondence, and follow up on pending requests to guarantee that services are not delayed.

Key Responsibilities

Surgical Authorization Management:

• Process and submit authorization requests for surgical procedures for 12-13 surgeons.
• Work with insurance companies to ensure proper documentation is submitted and approvals are obtained.
• Communicate with surgeons to clarify specific requirements or documentation for approvals.
• Track and monitor the status of surgical authorizations, ensuring that procedures are approved in a timely manner.
• Follow up on denied or pending authorizations and work on appeal processes when necessary.
  
  

Durable Medical Equipment (DME) Authorization

• Coordinate and submit authorization requests for necessary DME for patients.
• Review patient medical records to determine eligibility for DME based on insurance requirements.
• Liaise with equipment providers and insurance companies to ensure approvals are obtained promptly.
• Keep accurate records of DME requests, including denials and approvals.
• Gel and Xiaflex Injection Authorization:
• Handle authorization requests for Gel and Xiaflex injections for eligible patients.
• Review insurance policy guidelines to ensure these treatments are covered.
• Communicate with healthcare providers to verify treatment eligibility and requirements.
• Monitor the status of requests and follow up with insurance providers as needed to secure timely approvals.
  
  

STAT MRI Authorization

• Process and submit urgent authorization requests for STAT MRI procedures.
• Work closely with the medical team to gather appropriate documentation for expedited MRI approvals.
• Coordinate with insurance providers to secure timely authorization for emergency situations.
• Ensure accurate documentation of STAT MRI requests and follow-up to prevent delays in patient care.
  
  

Administrative Duties

• Maintain organized records of all authorizations, approvals, and communications for auditing purposes.
• Maintain up-to-date knowledge of insurance policies, procedural requirements, and authorization processes.
• Communicate effectively with insurance companies, medical staff, and patients regarding the status of authorization requests.
• Respond to patient inquiries regarding authorization status, providing clear and timely updates.
  
  

Qualifications

• Education: High school diploma or equivalent required. Associate's or Bachelor's degree in a healthcare-related field preferred.
• Experience: Minimum of 2 years of experience in a healthcare setting, specifically handling surgical, DME, or MRI authorization processes.
  
  

Skills

• Strong knowledge of insurance authorization processes.
• Excellent communication and interpersonal skills for interaction with patients, medical providers, and insurance companies.
• Detail-oriented and able to track and follow up on multiple authorization requests.
• Proficiency in medical terminology and insurance coding.
• Ability to manage time effectively and prioritize tasks in a fast-paced environment.
• Familiarity with electronic health records (EHR) and authorization software is a plus.
  
  

Work Conditions

• Full-time, Monday through Friday