What are the responsibilities and job description for the Revenue Cycle Specialist II- Surgery Authorization Specialist position at E.N.T. Specialty Partners?
Job Details
Description
The Surgical Authorization Specialist is responsible for obtaining insurance verification and benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to surgical services being rendered. This position will be responsible for handling patient questions regarding their benefits and associated fees prior to surgery. Timely communication with both payers, clinical team members, and patients is required to facilitate the patient’s surgical care. Minimum of 3 years experience required. Clinical background a plus.
Main functions of the role are the following:
- Verify insurance eligibility and benefits prior to service.
- Review and process surgery request for insurance authorizations in a timely and efficient manner.
- Communicate with insurance companies to ensure approvals for procedures are obtained before the scheduled surgery date.
- Obtain authorization for surgery when applicable.
- Request predetermination of surgery when necessary.
- Strong knowledge of payer and payer websites required.
- Calculation of patient estimated portion for surgery.
- Ability to read and interpret medical records to communicate effectively.
- Ensure all authorizations are compliant with healthcare regulations, payer policies, and internal procedures.
- Responsible for pre-certification, predetermination, and/or referral for services.
- Must understand payer medical policy and guidelines to determine requirements have been met for medical necessity.
- Collaborates with appropriate team members on cases that require escalation for peer-to-peer review.
- Continuous monitoring of pending surgery requests/reviews for final determination.
- Communicate with clinical and/or surgery scheduling team on any issues or denied services.
- Communicates with patients, clinical navigators, revenue cycle team, surgery schedulers and others when necessary to facilitate authorization process.
- Provides exceptional customer service to patients and healthcare providers by answering questions and providing updates regarding authorization status.
- Other duties deemed necessary.
Qualifications
MINIMAL REQUIREMENTS:
• High School Diploma or equivalent
• Minimum 3 years recent experience.
• Proficiency in CPT codes, ICD-10 codes, HCPC codes and use of modifiers
- Candidates must be able to work with high volume of work while maintaining attention to detail and accuracy and demonstrate excellent oral and written communication skills.
- Computer skills required to operate practice management system (i.e., use Window operating system conduct Internet searches, communicate by email, etc.)
- Ability to organize and manage multiple priorities commitment to company values
• Ability to work independently and with customers and insurance companies in a high-pressure environment while maintaining excellent customer service
• Basic math skills and accurately process money transactions (must be able to read & understand an EOB)
• Experience with office equipment: multi-functional printer/copier/fax, multi-line phone system, calculator, postage machine, and so on
• Must be proficient using the computer, data entry, and have above average typing skills
• Experience with MS Office, EMR/EPM systems
• Experience with eClinical Works Practice Management system preferred
• Prior experience with ENT specialty a plus
- CBO environment a plus
PHYSICAL DEMANDS:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to use hands to finger, handle, or feel objects, tools, or controls; walk; sit; stoop, reach; balance; talk or hear.
• Specific vision abilities required by the job include distance vision, color vision, peripheral vision, close vision, depth perception, and the ability to adjust focus.
• Work Environment: Office environment where the noise level is usually minimal.
*All employees are expected to adhere to all company policies. Job description may be changed at any time.
