Job Description

ESSENTIAL FUNCTIONS
· Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries
are obtained in a timely and accurate manner.
· Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms
necessary information to allow processing of claims to insurance plans.
· Accurately completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to
services.
· Verifies benefits on all surgical procedures.
· Document authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within
case management.
· Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good
working relationships with both internal and external customers.
· Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation
of surgical cases.
· Work with department manager to respond to and reduce complaints timely and professionally.
· Assist surgery schedulers with STAT authorizations.
· Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
· Assists in identifying opportunities for improvement within the daily workflow process.
· Attends department meetings as required.EDUCATION
· High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE
· A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations,
front office, and/or charge posting is preferred.
· Excellent organizational skills and strong customer service orientation are required with a strong background in computers
and data entry.

KNOWLEDGE
· Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial
payers, and other funding sources.

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