Surgery Scheduler/Prior Authorization Specialist na None

As the Surgery Scheduler/Prior Authorization Specialist, I report to the Director of Surgical Services. I create a connection with DOC guests and ensure that our value of tenacious caring occurs. I do this by understanding the value of communication, a helpful hand and the importance of relating to one’s needs.

Lead Outcome

• Ensure that all surgeries are preauthorized and scheduled according to company guidelines, while meeting facility and safety requirements

Core Responsibilities

• Empathetic and caring interactions with Guests
• Coordination with outside Providers, ancillary services and facilities for pre-operative clearance
• Coordinates and maintains physician OR and follow-up schedule 
• Coordinates with physician, guest and facility when scheduling cases 
• Manages OR block time at the facilities
• Maintains provider delineation of privileges to determine appropriateness of schedule
• Ensures instrumentation and anesthesia is coordinated 
• Enters patient demographics into EMR portals, ensures facility has all necessary paperwork needed to schedule a case
• Collects upfront monies due for surgery, assist in collecting balance dues if noted in the account
• Directs patient to get necessary clearance/pre-op testing completed prior to surgery and makes sure results are received and sent to the facility
• Facilitates the authorization process for all surgery, pain procedures and durable medical equipment.
• Communicates with providers and other team members of the guests’ authorization, having awareness of delays, and providing continual communication with all.
• Maintains compliance with payer-specific reimbursement guidelines.
• Responsible for tracking, obtaining, and extending authorizations from various carries in a timely manner.
• Follows-up on and has confirmation of all authorizations obtained; I work to help find solutions when denials are received.
• Verifies benefits information for guests and obtain test precertification/authorizations when necessary.
• Formation of pricing estimate based off benefits combined with recommended surgeries, pain procedures and durable medical equipment

I Exemplify the Following Competencies

• My leadership is proactive.
• My work shows great attention to detail.
• My behaviors and standards model DOC’s values and deliver a service experience that is unrivaled.
• I use active listening skills.
• My behavior is enthusiastic.
• I enjoy working as part of a team.
• I am flexible and adaptable.
• I am able to lift up to 50lbs.
• I am proficient in computer skills.