Authorizations Specialist

From the mountains to the coast, EmergeOrtho is North Carolina’s premier provider, recognized for offering world-class, comprehensive, and compassionate care serving patients with 60 locations in 28 counties. As the largest physician-owned orthopedic practice in the state and the 6th in the country, EmergeOrtho’s medical team includes upwards of 170 highly trained orthopedic specialists and nearly as many advanced practice providers. Our subspecialty orthopedic teams offer advanced expertise in conditions of the bones, muscles, and joints. Providing multiple locations, extensive orthopedic services including therapy, and focusing on continuity of care are among the top priorities of EmergeOrtho. Please visit https://emergeortho.com/careers/ for additional information.

EmergeOrtho, P.A. complies with applicable civil rights laws and does not discriminate based on race, color, religion, national origin, age, sex, gender identity or expression, sexual orientation, pregnancy, childbirth and related conditions, including but not limited to, lactation, disability, veteran status, genetic information, or any other class protected by the state or local law.

We are committed to the core values of Quality, Innovation, Compassion, Community, Education, Integrity, Teamwork, Diversity, and Inclusion. https://emergeortho.com/non-discrimination-notice/

Qualifications and Experience

• High school diploma or equivalent
• Previous experience in insurance billing and coding
• Minimum two years of patient service experience in a healthcare setting
• Ability to act with integrity, professionalism, and confidentiality
• Experience using electronic medical records systems
• Excellent communication and interpersonal skills
• Excellent organizational skills and attention to detail

Responsibilities include, but are not limited to the following

• Obtains orders from the physician
• Log all orders in EMR for accurate tracking and scheduling
• Eligibility, benefits, and authorization are obtained online or via telephone
• Respond to clinical requests by providing accurate information. Perform follow-up calls within 3 business days regarding the authorization status
• If a peer-to-peer review is needed prior to obtaining authorization, we will schedule with our physician and the insurance carrier’s Medical Director
• If the request is to have the patient be sent to an outside physician for treatment the office notes, patient demographics, and insurance card(s) are faxed to the outside physician’s office for an appointment
• Follow up on requests within 7-10 days to confirm accurate information has been received and confirm an appointment has been made
• Work diagnostic orders within 3-5 days of receipt. STAT orders are worked on immediately
• Obtain surgical authorizations 10 days prior to the surgery date unless the surgery is scheduled as a STAT
• Maintain the electronic log sheet, generated for physical therapy patients indicating patient demographics and therapy caps
• Maintains clinic and patient confidentiality
• Performs other duties as required and assigned by Manager, including schedule changes and travel to office locations as assigned