Job Description
Under general supervision, responsible for scheduling operating time of information systems operations in order to ensure that the information systems equipment is effectively utilized.
- Minimum of three (3) years of surgery scheduling experience and Highschool OR GED.
- Experience supporting providers with high clinic volumes and large surgical caseloads.
- Extensive knowledge of insurance referral and authorization requirements for outpatient and inpatient surgeries.
Experience obtaining authorizations for:
- Surgical procedures
- Biologic grafts and skin substitutes
Experience using payer portals such as:
- Availity
- NaviNet
- Carelon
- Evicore
- UHC Provider Portal
- Knowledge of CPT, ICD-10, and HCPCS coding.
- Experience with electronic medical records (preferably Epic).
Knowledge, Skills, and Abilities
- Ability to manage a fast-paced workload supporting multiple surgeons with significant surgical volume.
- Strong understanding of orthopedic procedures, implants, grafts, and biologic products.
- Knowledge of insurance coverage requirements for grafts, skin substitutes, and specialty products used in clinic and surgery.
- Ability to navigate multiple insurance websites and portals to submit and track authorization requests.
- Strong organizational skills with the ability to prioritize urgent cases and meet payer deadlines.
- Excellent communication skills for coordinating with patients, providers, surgery centers, hospitals, and insurance representatives.
- Proficiency in Microsoft Office (Excel, Word, Outlook).
- High attention to detail and accuracy.
Key Job Duties
- Schedule orthopedic surgical procedures, injections, and related treatments for multiple high-volume providers.
Obtain and track referrals and prior authorizations for surgeries, grafts, biologic products.
- Verify insurance benefits and determine medical necessity requirements.
- Submit clinical documentation through insurance portals and follow up on pending requests.
- Coordinate pre-operative testing, medical clearances, and surgical facility requirements.
- Coordinate biologic grafts, skin substitutes, and specialty implants used in clinic and the operating room.
- Educate patients regarding surgical dates, financial responsibilities, and pre-operative/post-operative instructions.
- Communicate with hospitals, ambulatory surgery centers, vendor representatives, and insurance companies.
- Reconcile completed surgeries to ensure procedures, implants, and authorizations match services rendered.
- Assist with appeals and peer-to-peer reviews when authorizations are denied.
- Maintain accurate documentation in the electronic medical record.
Ideal Candidate Profile
The ideal candidate thrives in a fast-paced orthopedic environment, can independently manage complex insurance and authorization workflows, and is comfortable coordinating large surgical volumes while ensuring grafts.
- Excellent verbal and written communication skills; Bilingual (Spanish and English) preferred.
- Strong computer skills including Microsoft Word, Excel, PowerPoint and Outlook.
- Some medical experience.
- Previous surgery scheduling experience.
- Previous electronic medical record (EMR) experience.
- Knowledge of ICD-10 and CPT coding.
Required Skills
Three (3) years of professional experience is required.
SkillType
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SkillId
300001501280384
SectionId
300000006778627
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