Surgery Authorization Specialist

Description

Job Title: Surgery Authorization Specialist 

Reports To: Director Business Office 

FLSA Status: Non-Exempt 

Employment Status:  Full-Time 

Location: Tulsa, OK 

Work Schedule:  8:00AM – 5:00PM Monday-Friday 

Travel Requirements: None 

Position Summary 

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. 

Primary Duties and Responsibilities 

• 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 utilize payer websites and portals to submit, obtain, track, and follow up on authorizations to help prevent procedure delays, rescheduling, or cancellations. 
• Maintain accurate and timely documentation of authorization status, insurance benefits, patient financial responsibility, and communications with patients, payers, and clinical staff. 
• Communicate effectively with patients, clinical staff, surgery scheduling personnel, insurance representatives, and other healthcare team members; identify and escalate unresolved or complex authorization issues as appropriate. 
• 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 duties consistent with the position, as assigned. 

Qualifications 

• Education:  
• High school diploma or equivalent required. 
• Experience:  
• Minimum of two (2) years of medical prior authorization experience, preferably involving surgical procedures.  
• Experience with insurance benefit verification and healthcare revenue-cycle processes preferred. 
• Knowledge / Abilities: 
• 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 Electronic Medical Record (EMR/EHR) systems and Microsoft Office. 
• Strong organizational skills with the ability to prioritize responsibilities, manage deadlines, multitask, and maintain attention to detail. 
• Ability to work independently while also contributing effectively as a member 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. 

Physical Demands 

• Frequent sitting, standing, walking, reaching, and use of a computer, telephone, and other standard office equipment. 
• Ability to visually review electronic and written documentation and accurately enter information into computer systems. 
• Ability to communicate effectively in person, by telephone, and through electronic communication. 
• Ability to perform the essential functions of the position, with or without reasonable accommodation. 

Work Environment 

• Primarily an office or administrative healthcare environment. 
• Regular interaction with patients, clinical staff, providers, insurance representatives, and other healthcare personnel. 
• Fast-paced environment with frequent interruptions and changing priorities. 
• May have occasional exposure to clinical areas and healthcare environments. 
• May be required to follow applicable infection prevention, confidentiality, and workplace safety procedures when entering clinical areas.