Provides administrative and insurance authorization support to facilitate timely scheduling and completion of surgical procedures. Responsible for obtaining required prior authorizations and referrals, verifying patient insurance eligibility and benefits, documenting authorization information, and communicating with patients, insurance representatives, clinical staff, and surgery scheduling personnel. Supports accurate, efficient, and compliant processes while maintaining patient confidentiality and organizational standards.
Key responsibilities include:
- Review patient charts and clinical documentation; obtain required prior authorizations and referrals for surgical procedures in accordance with payer requirements and organizational procedures.
- Verify patient insurance eligibility and benefits, including deductibles, coinsurance, out-of-pocket maximums, and other applicable financial responsibilities.
- Communicate estimated patient responsibility and collect required amounts, as applicable.
- Contact insurance companies and use payer websites and portals to submit, obtain, track, and follow up on authorizations.
- Maintain accurate and timely documentation of authorization status, insurance benefits, patient financial responsibility, and communications.
- Communicate with patients, clinical staff, surgery scheduling personnel, insurance representatives, and other healthcare team members.
- Maintain patient confidentiality and comply with HIPAA, organizational policies, and applicable regulatory and payer requirements.
- Participate in department meetings, process-improvement initiatives, staff training, onboarding, special projects, and other assigned duties.
Requirements & Qualifications
High school diploma or equivalent required.
Experience and skills:
- Minimum of 2 years of medical prior authorization experience, preferably involving surgical procedures.
- Experience with insurance benefit verification and healthcare revenue-cycle processes preferred.
- Knowledge of insurance authorization and benefit verification processes.
- Ability to navigate insurance company websites and payer portals.
- Strong computer and data-entry skills.
- Experience with EMR/EHR systems and Microsoft Office.
- Strong organizational skills with the ability to prioritize, manage deadlines, multitask, and maintain attention to detail.
- Ability to work independently and as part of a team.
- Ability to interpret and follow payer requirements, organizational procedures, and established workflows.
- Ability to communicate professionally with patients, insurance representatives, providers, and coworkers.
Location
Tulsa, Oklahoma, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago