Job Information
Job Order ID :
WI3799821
# of Positions :
1
Minimum Education Level :
High School Diploma/GED
Experience Required :
Training :
High School Diploma/GED Equivalent
Duration :
Shift :
Unspecified
Hours per week:
40
Job Description
JOB REQUIREMENTS: Position Description: As the Surgical Prior
Authorization Coordinator III in Orthopaedic Surgery you will be
responsible for managing the process of securing prior authorizations
for surgical procedures and services. This role involves assigning or
verifying CPT codes based on provider documentation, verifying insurance
coverage, coordinating with healthcare providers, and communicating with
insurance companies to ensure that patients receive the necessary
approvals for their surgical treatments. Primary Functions Assign and/or
verify CPT, ICD-10 CM coding, and modifiers based upon provider
documentation. Keep coding and documentation resources for the providers
and surgery schedulers updated on a continuous basis. For clinical
procedures and special handle procedures: Initiate and manage the
process of obtaining prior authorizations from insurance companies.
Ensure that medical necessity requirements are met and work with
healthcare providers to gather necessary documentation. Collaborate with
healthcare providers, insurance companies, and patients to facilitate
the authorization process and address any issues or discrepancies.
Manage departmental drug inventory and distribution. If a surgical
authorization is denied, work with clinical team as needed. Stay updated
on relevant regulations and insurance policies to ensure compliance with
all guidelines. Identify and report trends in surgical authorization
denials and work with the Sr. Reimbursement Manager to implement quality
improvement measures. Collaborate with surgical schedulers and
healthcare providers to ensure that scheduled surgeries align with
approved authorizations. Provide patients with information about the
prior authorization process and their financial responsibilities,
answering any questions or concerns. Provides assistance, training,
and/or coverage to other team members as needed, acts as valuable
resource for all surgeons and APPs in the Department. Knowledge -
Skills - Abilities Previous experience in healthcare administration,
medical billing, or revenue cycle management. Knowledge of surgical
procedures, medical terminology, and the surgical authorization process.
Strong communication and interpersonal skills. Attention to detail and
the ability to work in a fast-paced, deadline-driven environment.
Knowledge of insurance verification processes and healthcare compliance
regulations. Familiarity with electronic health record (EHR) systems.
Coding experience related to surgical procedures or coding certification
(CPC, CPC-A, CCS-P, CCA, RHIT, or RHIA) #LI-SN1 Preferred Schedule:
Position\... For full info follow application link. EEO/AA
Minorities/Females/Vets/Disability The Medical College of Wisconsin is
an affirmative action/equal opportunity employer and does not
discriminate in hiring or employment on the basis of age, sex, race,
color, religion, national origin, veteran status, disability or sexual
orientation. \*\*\*\*\* APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/8BE40DA4C0124DCD Qualified females, minorities, and special
disabled veterans and other veterans are encouraged to apply.
Company Information
Name :
MCW: SARGEANT HEALTH CENTER
Application Information