Job Description

The Prior Authorization Specialist & Surgical Scheduler is responsible for securing insurance authorizations and coordinating surgical and procedural scheduling for patients. This role serves as a critical liaison between providers, patients, insurance companies, ambulatory surgery centers (ASC), hospitals, and other healthcare partners to ensure timely authorizations, accurate scheduling, and seamless patient care coordination. The ideal candidate possesses strong knowledge of insurance verification, prior authorization processes, surgical scheduling workflows, and healthcare compliance requirements.

Key Responsibilities:

Prior Authorization & Insurance

• Obtain and manage prior authorizations for surgical and medical procedures.
  
• Verify insurance requirements and ensure all necessary documentation is submitted accurately.
  
• Follow up with insurance carriers on authorization status and resolve coverage issues.
  
• Assist with denied claims related to authorization and support appeals when needed.
  
• Communicate authorization approvals, denials, and requirements to providers and staff.
  

Surgical Scheduling & Coordination

• Schedule surgical procedures at hospitals and ambulatory surgery centers (ASCs).
  
• Coordinate procedure dates with surgeons, facilities, patients, and other healthcare partners.
  
• Prepare and submit surgical booking forms and resolve scheduling discrepancies.
  
• Coordinate vendor representatives and other resources required for procedures.
  
• Manage schedule changes, cancellations, and procedure confirmations.
  

Administrative & Compliance

• Maintain accurate patient records and scheduling documentation.
  
• Ensure compliance with HIPAA, payer requirements, and regulatory guidelines.
  
• Collaborate with clinical, billing, and administrative teams to support patient care.
  
• Perform additional duties as assigned to support operational efficiency.
  

Qualifications:

• Bachelor's Degree in Healthcare Administration, Medical Office Administration, Health Information Management, Business Administration, or a related field is preferred.
• At least 1-year end-to-end experience in Prior Authorization
• At least 6 months experience in surgical scheduling, ambulatory surgery center (ASC) coordination, hospital scheduling, or specialty medical practices such as orthopedics, spine, neurosurgery, pain management, ENT, or general surgery.

Preferred Skills:

Candidates should have a solid understanding of commercial insurance, Medicare, Medicaid, workers' compensation, and automobile accident claims. They should be familiar with prior authorization requirements, payer guidelines, revenue cycle processes, healthcare compliance standards, HIPAA regulations, and surgical scheduling procedures within hospital and ambulatory surgery center environments.