Job Description

Position Overview: We are seeking a highly organized and detail-oriented Pre-Authorization Specialist to join our team at Ortho Sport & Spine Physicians. This role is essential in ensuring that patients receive timely care by managing insurance pre-authorizations for a variety of services including internal MRI, interventional spine procedures, surgeries, and durable medical equipment (DME). The ideal candidate will have experience in navigating insurance processes, strong communication skills, and a commitment to providing exceptional patient support.

Key Responsibilities:

• Submit and track authorization requests with insurance companies for procedures such as MRI, spine interventions, surgeries, and DME orders.
• Review and verify order details and insurance coverage, obtain necessary pre-authorizations, and communicate coverage and financial details to both patients and healthcare providers.
• Notify patients and providers when services are not authorized by insurance and offer alternative solutions.
• Proactively monitor upcoming schedules for authorization status, contacting patients with rescheduling or payment options if authorizations are pending.
• Collaborate with intra-office teams to streamline the authorization process and ensure efficient communication.
• Prioritize tasks based on authorization timelines, insurance requirements, and clinical urgency.
• Obtain retroactive authorizations when required.
• Ensure all documentation and records are maintained accurately and in a timely manner to support continuity of care.
• Perform additional duties as assigned to support the team.

Qualifications:

• High school diploma or GED required; college degree preferred.
• Minimum of 2 years of experience in medical billing or authorization processes, preferably in an orthopedic or medical setting.
• In-depth knowledge of pre-authorization, pre-certification, and health insurance claims.
• Familiarity with CPT, ICD-9/10 coding, Medicare, OSHA, HIPAA, and other relevant regulations.

Key Skills and Attributes:

• Strong understanding of insurance procedures and third-party payer systems.
• Excellent written and verbal communication skills, with an emphasis on patient interaction and customer service.
• Ability to prioritize tasks, manage multiple responsibilities, and work effectively in a fast-paced environment.
• Strong attention to detail and the ability to maintain accurate records.
• Ability to build and maintain positive relationships with staff, patients, and insurance providers.

If you have the experience, skills, and dedication to succeed in a fast-moving healthcare environment, we encourage you to apply!

Ortho Sport and Spine Physicians is an Equal Opportunity Employer and does not discriminate in its employment practices on the basis of race, religion, sex, color, national origin, age, disability, citizenship, genetic information, veteran status, military service, or any other characteristic protected by federal law or Georgia law.P

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