Boulder CO
Prior Authorization Specialist
Boulder CO - Boulder, Colorado, United States, 80301
Work at Boulder CO
Overview
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Overview
Description
Job Overview:
The Authorization Specialist is responsible for pre-authorizing services including MRI, therapy, surgery, and durable medical equipment (DME) for the practice. This role includes verifying insurance benefits, obtaining pre-certifications and authorizations from payors, submitting necessary documentation, and assisting patients with understanding their financial obligations. The specialist will monitor the authorization status of scheduled patients and reschedule appointments as necessary pending completed authorization. Department:
Administrative Reports to:
Prior Authorization Manager Schedule/Type:
Full-Time M-F/ Hourly Overtime Status:
Non-exempt Wage:
$20-32 per hour, commensurate with experience Requirements Essential Job Responsibilities: Submit and follow up on authorization requests with insurance companies for internal MRI, therapy, surgery, and DME orders. Verify order contents and insurance coverage upon receipt, obtain pre-authorization, and communicate benefits eligibility and financial details to patients and practitioners. Notify patients and practitioners of any services requested that are not authorized by insurance. Review upcoming schedules for authorization status and contact patients with payment/rescheduling options if authorization is not obtained. Utilize intraoffice communication and resources to support the authorization process. Prioritize workflow based on authorization timeframes, insurance requirements, and urgency. Obtain retroactive authorizations as needed. Maintain accurate and timely documentation and records for continuity of patient care. Perform other duties as assigned. Education/Experience: High school diploma or GED required. College degree preferred. Minimum of 2 years of experience in billing/authorization preferred. Experience in an orthopedic or medical setting preferred. Familiarity with pre-authorization, pre-certification, and health insurance claims processing preferred Performance Requirements: Knowledge of
insurance processes, third-party payers, basic coding (CPT, ICD-9), Medicare compliance, OSHA, HIPAA, and relevant regulations. Skills in
written and verbal communication, customer service, math, and organization. Ability to
prioritize tasks, multitask, and work effectively in a fast-paced environment while maintaining cooperative relationships with staff and patients. Benefits: Company Paid Benefits Employee HDHP Plan Basic Life/AD&D Guardian 16 days of PTO per year 7-7.5 paid holidays per year Employee Assistance Program 401(k) Safe Harbor Contribution Benefit Options Requiring Employee Contributions Medical Health Savings Account Dental Vision Short-Term Disability Voluntary Life and AD&D Flex Spending Accounts General Purpose Healthcare FSA Optional Protection Benefits (Accident, Hospital Indemnity, Cancer Care and Critical Illness Insurance) 401(k) Closing Date: May 15th, 2025 Boulder Centre for Orthopedics is proud to be an Equal Opportunity employer. We are committed to providing equal employment opportunities to all qualified individuals without regard to race, color, religion, sex, national origin, age, disability, genetic information, marital status, sexual orientation, gender identity or expression, veteran status, or any other characteristic protected by applicable law. Our hiring decisions are based solely on qualifications, merit, and business needs. We encourage diverse candidates to apply and welcome the opportunity to build a talented and inclusive workforce. In our recruitment and employment practices, we adhere to applicable federal, state, and local laws, ensuring fairness and inclusivity in all aspects of employment. We value diversity and believe that a diverse workforce enhances our ability to serve our patients and community effectively. All qualified individuals are encouraged to apply, regardless of background or identity. #J-18808-Ljbffr
The Authorization Specialist is responsible for pre-authorizing services including MRI, therapy, surgery, and durable medical equipment (DME) for the practice. This role includes verifying insurance benefits, obtaining pre-certifications and authorizations from payors, submitting necessary documentation, and assisting patients with understanding their financial obligations. The specialist will monitor the authorization status of scheduled patients and reschedule appointments as necessary pending completed authorization. Department:
Administrative Reports to:
Prior Authorization Manager Schedule/Type:
Full-Time M-F/ Hourly Overtime Status:
Non-exempt Wage:
$20-32 per hour, commensurate with experience Requirements Essential Job Responsibilities: Submit and follow up on authorization requests with insurance companies for internal MRI, therapy, surgery, and DME orders. Verify order contents and insurance coverage upon receipt, obtain pre-authorization, and communicate benefits eligibility and financial details to patients and practitioners. Notify patients and practitioners of any services requested that are not authorized by insurance. Review upcoming schedules for authorization status and contact patients with payment/rescheduling options if authorization is not obtained. Utilize intraoffice communication and resources to support the authorization process. Prioritize workflow based on authorization timeframes, insurance requirements, and urgency. Obtain retroactive authorizations as needed. Maintain accurate and timely documentation and records for continuity of patient care. Perform other duties as assigned. Education/Experience: High school diploma or GED required. College degree preferred. Minimum of 2 years of experience in billing/authorization preferred. Experience in an orthopedic or medical setting preferred. Familiarity with pre-authorization, pre-certification, and health insurance claims processing preferred Performance Requirements: Knowledge of
insurance processes, third-party payers, basic coding (CPT, ICD-9), Medicare compliance, OSHA, HIPAA, and relevant regulations. Skills in
written and verbal communication, customer service, math, and organization. Ability to
prioritize tasks, multitask, and work effectively in a fast-paced environment while maintaining cooperative relationships with staff and patients. Benefits: Company Paid Benefits Employee HDHP Plan Basic Life/AD&D Guardian 16 days of PTO per year 7-7.5 paid holidays per year Employee Assistance Program 401(k) Safe Harbor Contribution Benefit Options Requiring Employee Contributions Medical Health Savings Account Dental Vision Short-Term Disability Voluntary Life and AD&D Flex Spending Accounts General Purpose Healthcare FSA Optional Protection Benefits (Accident, Hospital Indemnity, Cancer Care and Critical Illness Insurance) 401(k) Closing Date: May 15th, 2025 Boulder Centre for Orthopedics is proud to be an Equal Opportunity employer. We are committed to providing equal employment opportunities to all qualified individuals without regard to race, color, religion, sex, national origin, age, disability, genetic information, marital status, sexual orientation, gender identity or expression, veteran status, or any other characteristic protected by applicable law. Our hiring decisions are based solely on qualifications, merit, and business needs. We encourage diverse candidates to apply and welcome the opportunity to build a talented and inclusive workforce. In our recruitment and employment practices, we adhere to applicable federal, state, and local laws, ensuring fairness and inclusivity in all aspects of employment. We value diversity and believe that a diverse workforce enhances our ability to serve our patients and community effectively. All qualified individuals are encouraged to apply, regardless of background or identity. #J-18808-Ljbffr