Surgery Coordinator

Description

Job Summary: The Financial Clearance team is responsible for managing all pre-appointment insurance processes including benefits verification, cost estimates, and prior authorizations.

Supervisory Responsibilities: N/A

Essential Duties / Responsibilities:

• •Verify insurance benefits for all patients and accurately document details in Athena.
• •Understand insurance criteria and requirements for various treatments.
• •Review clinical records to confirm that criteria are met for authorization.
• •Initiate pre-authorization or predetermination requests with insurance companies, submitting all necessary clinical documentation via fax or portal.
• •Monitor the status of surgical reviews according to established protocols.
• •Document authorization request determinations following protocol.
• •Manage patient cases throughout the insurance review and authorization process.
• •Communicate any adverse determinations to the clinic staff promptly.
• •Create cost estimates for procedures, including both insurance-approved treatments and self-pay.
• •Maintain a log of surgical procedures ordered and those under insurance review.
• •Process incoming and outgoing faxes related to insurance authorizations.
• •Handle incoming and outgoing calls with patients and insurance representatives regarding surgical authorizations.
• •Contact patients to schedule procedures, review cost estimates, and provide pre/post-operative instructions for specific surgical procedures.
• •Communicate with the clinical team regarding questions on benefits, estimates, or authorizations.
• •Provide support and training assistance to team members when needed.

Required Skills / Abilities:

• •Positive and professional demeanor
• •Strong conflict resolution and problem-solving skills
• •Collaborative team player focused on achieving optimal outcomes
• •Excellent verbal and written communication skills across multiple channels
• •Thorough understanding of insurance coverage and policy requirements
• •Self-motivated with the ability to work independently
• •Flexible and adaptable; able to multitask effectively in a fast-paced environment
• •Perform well under pressure and manages time efficiently
• •High attention to detail and accuracy
• •Reliable and dependable work ethic
• •Open to feedback and demonstrates growth from constructive input
• •Proficient in Microsoft Office applications
• •Maintains strict compliance with HIPAA regulations
• •Perform other related duties as assigned.

Education and Experience:

• •High School Diploma or GED required
• •Medical Assistant Certification preferred

*StrideCare is an Equal Opportunity Employer and is committed to diversity and inclusion in our workforce. We encourage applications from candidates of all backgrounds and experiences.

Requirements

• •Ability to sit for extended periods while working on a computer.
• •Manual dexterity to operate standard office equipment, including computers, phones, and fax machines.
• •Ability to occasionally lift and carry items weighing up to 20 pounds.
• •Sufficient visual acuity to perform tasks involving computer screens and paper documents.
• •Ability to move throughout the office to access files, equipment, and other necessary resources.
• •Home office requirements: Maintain a dedicated workspace that is professional, organized, and free from distractions.
• •Have a reliable high-speed internet connection capable of supporting voice calls, data entry, and system usage without interruption.
• •Ensure workspace security and confidentiality, adhering to company policies on data protection and HIPAA privacy standards.