Surgical Prior Authorization and Support Specialist

Position Summary:

The Surgery Prior Authorization and Support Specialist is responsible for obtaining and managing prior authorizations for Mohs surgical procedures to ensure timely approval and reimbursement. This role supports clinical and administrative operations by coordinating with insurance carriers, patients, providers, and referring offices. The position also includes various administrative support duties to support the surgical team and office flow.

• Obtain prior authorizations for surgical procedures
• Verify patient insurance eligibility, benefits, and coverage
• Submit required clinical documentation to insurance companies and follow up on approval status
• Communicate with appropriate staff authorization status and document in the patient's chart accordingly
• Create new patient charts ensuring all required documents are obtained and scanned in patient's chart properly
• Enter and update patient's insurance accurately into the practice management system
• Request and maintain medical records from referring offices to ensure receipt of required documents
• Assist with scheduling when needed
• Maintain confidentiality in accordance with HIPPA guidelines
• Provide general administrative support to the surgical team
• Perform all other support duties as assigned

• High school diploma or equivalent required
• Minimum of 2 - 3 years of prior authorization experience, preferably in a surgical or specialty setting
• Knowledge of Insurance plans, CPT/ICD-10 coding, and authorization process
• Experience with EMR
• Strong organizational skills and detail oriented
• Excellent communication and follow-up skills
• Ability to multitask in a fast-paced environment
• Self-motivated and ability to work independently