Medical Pre-Authorization Specialist

Pre-Authorization Specialist

Typical Schedule: Monday-Friday 8:30am-5:00pm

Job Type: Full Time

We always strive to make your experience at Nebraska Orthopaedic Center a friendly, comfortable, and positive one. We want you to feel you received the same high-quality care we would offer a member of your own family. At NOC, we strive to be your healing destination.

• Obtains, reviews and organizes all scheduled surgeries.
• Prioritize work based on date of service.
• Monitors surgery schedules for additions, changes, and cancellations.
• Obtains and reviews surgical orders from NOC clinic staff through the EMR.
• Ensure CPT codes are accurate, and surgical orders align with physician notes and treatment plans; verify with surgical coding team when necessary.
• Communicates with clinical staff, transcription, hospitals, and surgery centers when additional information is required.
• Contacts insurance companies, workers’ compensation carriers, and third-party liability carriers to obtain pre-authorizations and medical policy information.
• Submits physician notes, PT notes, reports, and other required documentation for authorization.
• Faxes or electronically submits records and reports as requested.
• Monitors pending authorizations and follow up as needed.
• Attaches authorization approvals and denials in the patient EMR and surgery case.
• Communicates approvals/denial updates to the clinical team.
  
  Facilitates peer‑to‑peer review requests by communicating the information to the physician scheduler or clinical team.
• Submits appeal letters once completed by a physician.
• Notifies insurance companies, workers’ compensation and third‑party liability carriers for surgical changes and cancellations.
• Responds to all phone calls and emails from hospitals and surgery centers regarding pre‑authorizations.
• Escalates issues to management when appropriate.
• Maintains regular and reliable attendance as an essential function of the position.

• High school diploma or GED.
• One year’s experience in a health care organization is preferred.

• Knowledge of insurance pre‑authorization requirements.
• Knowledge of medical terminology, diagnosis, and procedure codes.
• Skill in problem solving, decision‑making, and in dealing effectively with staff, patients, hospitals, insurance companies and the public.
• Skill in using office equipment (i.e. computer, fax, scanner, copier).
• Ability to maintain accurate information and documentation.
• Ability to organize time and tasks appropriately.

Schedules can vary depending on department needs.

EOE

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Free parking
• Health insurance
• License reimbursement
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance