Healthcare Outcomes Performance Co. (HOPCo)
Procedure Authorization Specialist
Healthcare Outcomes Performance Co. (HOPCo), Phoenix, Arizona, United States, 85003
Responsibilities
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.
Documents 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.
Participates in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
Works with the department manager to respond to and reduce complaints in a timely and professional manner.
Assists surgery schedulers with STAT authorizations.
Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines.
Assists in identifying opportunities for improvement within the daily workflow process.
Attends department meetings as required.
Qualifications
High school diploma/GED or equivalent working knowledge preferred.
Minimum of 2 years of experience in the healthcare field. Previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
Excellent organizational skills and strong customer service orientation with a strong background in computers and data entry.
Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
Knowledge of federal, state, and HIPAA privacy regulations.
Computer application knowledge – Microsoft Excel, Word, Outlook.
Organization requires reading and signing the HOPCo Mission, Vision, and Values.
Working Conditions
Normal office environment.
Requires sitting and standing; some bending and stretching are required.
Manual dexterity using a calculator and computer keyboard.
Ability to multi‑task in a fast‑paced environment; must be detailed‑oriented with strong organizational skills.
Ability to understand patient demographics, determine insurance eligibility, analyze data, and communicate effectively and compassionately with patients, co‑workers, management, and providers.
Additional Information This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.
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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.
Documents 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.
Participates in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
Works with the department manager to respond to and reduce complaints in a timely and professional manner.
Assists surgery schedulers with STAT authorizations.
Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines.
Assists in identifying opportunities for improvement within the daily workflow process.
Attends department meetings as required.
Qualifications
High school diploma/GED or equivalent working knowledge preferred.
Minimum of 2 years of experience in the healthcare field. Previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
Excellent organizational skills and strong customer service orientation with a strong background in computers and data entry.
Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
Knowledge of federal, state, and HIPAA privacy regulations.
Computer application knowledge – Microsoft Excel, Word, Outlook.
Organization requires reading and signing the HOPCo Mission, Vision, and Values.
Working Conditions
Normal office environment.
Requires sitting and standing; some bending and stretching are required.
Manual dexterity using a calculator and computer keyboard.
Ability to multi‑task in a fast‑paced environment; must be detailed‑oriented with strong organizational skills.
Ability to understand patient demographics, determine insurance eligibility, analyze data, and communicate effectively and compassionately with patients, co‑workers, management, and providers.
Additional Information This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.
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