Authorization Specialist
About the Job
- Job Title: Authorization Specialist
- Company: The Orthopedic Partners
- Location: Cottonwood Heights or Park City
- City: Cottonwood Heights or Park City
- Start Date: January 2025
- Classification: This is a full-time, non-exempt position with benefits. If you're interested in part-time, please apply, we're open to discussing alternative schedules.
Description: As an Authorization Specialist in an Orthopedic Office, your primary responsibility is to navigate the complex insurance landscape and ensure proper authorization is obtained for orthopedic services. You will work closely with patients, healthcare providers, insurance companies, and other stakeholders to verify insurance coverage and resolve billing-related issues. Your knowledge of insurance processes, attention to detail, and effective communication skills will contribute to the financial success and compliance of the orthopedic office.
Primary Responsibilities:
Insurance Verification:
- Verify patient insurance coverage, benefits, and eligibility for orthopedic services.
- Collect and update patient insurance information accurately in the electronic health record (EHR) system.
- Communicate with insurance companies to obtain detailed information about coverage limitations, preauthorization requirements, and billing guidelines.
Insurance Authorization:
- Contact insurance companies for necessary authorization of services for patient appointments.
- Utilize online services from insurance companies to obtain authorizations and/or gather information regarding patients' coverage for services.
- Process all items for review in the practice management system.
- Ensure authorizations are up to date, entering authorizations into EHR, scanning and linking authorizations to the patient's chart.
- Document all information obtained in the practice management system to adequately relay said information to all staff.
Compliance and Documentation:
- Ensure compliance with coding and billing regulations, including HIPAA and other industry guidelines.
- Maintain accurate and up-to-date documentation of insurance-related activities, including authorizations, claims, appeals, and communication with insurance companies.
Requirements:
- High school diploma or equivalent (additional education or certification in medical billing, coding, or healthcare administration is a plus).
- Proven experience in medical insurance verification, billing, or similar roles in a healthcare setting, preferably in an orthopedic office.
- In-depth knowledge of medical insurance processes, including verification, preauthorization, claims submission, and reimbursement.
- Familiarity with orthopedic procedures, terminology, and coding systems (ICD-10-CM, CPT, and HCPCS).
- Strong understanding of insurance guidelines, regulations, and billing requirements Proficiency in using computer systems and software for insurance verification, claims submission, and electronic health records.
- Excellent communication skills, both verbal and written, to interact effectively with patients, healthcare providers, insurance companies, and other stakeholders.
- Strong attention to detail and accuracy in data entry, documentation, and claims processing.
- Ability to handle confidential and sensitive information with discretion.
- Strong problem-solving and analytical skills to identify and resolve billing-related issues
- Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment
- Knowledge of medical terminology, anatomy, and orthopedic-specific procedures is desirable
Salary and Benefits:
- We offer competitive compensation and benefits packages.
- Health Insurance (Medical, Dental, Vision)
- Company 401k contribution
- Paid Time Off
- Paid Holidays
- Life Insurance Short- and Long-Term Disability Insurance
Application Process: To apply for this position, please submit your resume to dmoore@toportho.com. We
appreciate your interest in joining The Orthopedic Partners Clinic team. Only candidates
selected for further consideration will be contacted.
Note: This job description is intended to outline the general nature and level of work being
performed by employees in this role. It is not intended to be an exhaustive list of all
responsibilities, duties, and skills required.
We are an Equal Opportunity Employer. We are committed to equal treatment of all employees without regard to race, national origin, religion, gender, age, sexual orientation, veteran status, physical or mental disability, or other basis protected by law.