Schedule:
- Monday through Friday, 8:00am to 4:30pm
Company Overview
Capital Women's Care is a leading healthcare provider specializing in obstetric, gynecologic, and women’s health services. Our extensive network of physicians, nurse practitioners, physician assistants, and certified nurse midwives ensures comprehensive care and rapid coordination with specialists to meet each patient's unique medical needs.
Overview
A busy Gynecologic Oncology practice is seeking a highly motivated, organized, and detail-oriented Pre-Authorization & Surgical Scheduling Coordinator. This position is primarily responsible for obtaining insurance authorizations and ensuring patients are financially cleared for surgical procedures and related services. The role also provides administrative support to the Surgical Scheduling team by preparing surgical packets, assisting with scheduling activities, and serving as backup coverage when Surgical Coordinators are out of the office. The ideal candidate is able to manage multiple priorities, communicate effectively with patients, providers, hospitals, and insurance companies, and thrive in a fast-paced healthcare environment.
Responsibilities
Responsibilities performed on a regular basis include:
- Verify insurance eligibility and benefits for surgical patients.
- Submit, monitor, and follow up on prior authorization requests through payer portals, telephone, and electronic systems.
- Monitor authorization denials and coordinate appeals and peer-to-peer (P2P) reviews when required, including obtaining supporting clinical documentation and following up on final determinations
- Obtain referrals when required by insurance plans.
- Assist with preparation and organization of surgical packets prior to scheduled procedures.
- Assist with scheduling surgeries, pre-operative appointments, post-operative visits, and diagnostic testing when additional support is needed.
- Coordinate medical clearances and pre-operative testing with referring providers and patients.
- Track receipt of medical clearances, laboratory results, pathology reports, imaging, and other required documentation.
- Fax or electronically transmit required documentation to hospitals, surgery centers, and physician offices.
- Answer patient telephone calls regarding authorization status, surgery preparation, and scheduling questions.
- Check voicemail regularly and return patient and provider calls in a timely manner.
- Assist with rescheduling surgeries or appointments due to authorization delays, physician availability, or facility changes.
- Support departmental workflow by assisting with administrative projects and other duties as assigned.
Skills
- Strong knowledge of medical insurance plans, prior authorization requirements, and payer guidelines.
- Experience working with commercial insurance, Medicare, Medicaid, and managed care plans preferred.
- Excellent organizational, prioritization, and time management skills.
- Strong attention to detail and accuracy.
- Ability to manage multiple authorization requests simultaneously while meeting deadlines.
- Excellent verbal and written communication skills with patients, providers, hospitals, surgery centers, and insurance representatives.
- Proficient computer skills, including electronic medical records (EMR), Microsoft Office, and insurance payer portals.
- Ability to explain insurance and authorization requirements to patients in a compassionate and professional manner.
- Strong problem-solving and critical thinking skills.
- Ability to work independently while collaborating effectively with physicians, Surgical Coordinators, clinical staff, and management.
- Professional demeanor with a strong commitment to customer service.
- Ability to maintain confidentiality and comply with HIPAA and organizational policies and procedures.
- Flexibility to provide backup support to the Surgical Scheduling team when operational needs require.
Join our team as a Pre-Authorization & Surgical Scheduler to contribute significantly to streamlined surgical workflows while providing exceptional support to our patients and healthcare professionals!
Experience
- 2 years' experience as Surgical Scheduler with and corresponding knowledge of insurance eligibility and authorization is required.
- 3 years’ experience in a medical office
Education
- High School Diploma or equivalent is required.
- Certified Medical Assistant - required
Preferred Qualifications
- Minimum of 2 years of experience in medical prior authorizations, surgical scheduling, or healthcare insurance verification.
- Experience in oncology, gynecology, surgery, or another specialty practice preferred.
- Knowledge of CPT, ICD-10, and medical terminology.
- Experience using electronic health records and insurance authorization systems.
- Bilingual (English/Spanish) is a plus.
Equal Opportunity Employment:
CWC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status. If you are selected for further consideration, you will be subject to a background investigation and drug screening. Flu vaccination is a required condition of employment. Reasonable accommodation may be made to enable individuals with disabilities to perform these essential functions. This job description has been approved by all levels of management.
Pay: $24.00 - $26.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Paid time off
- Vision insurance
Work Location: In person
