OMFS Prior Authorization Specialist

Oral Surgery Utilization Specialist

The Oral Surgery Utilization Specialist is responsible for correctly and efficiently facilitating the prior authorization and scheduling process for Oral Maxillofacial Surgery patients, by ensuring that authorization is obtained. Communicate financial responsibility to the clinic scheduler and front desk personnel if needed. Works to ensure that Medicaid information is accurate and, in cases of other commercial insurance, ensures that member information is accurate. Facilitate the flow of information between the provider, insurance company and the patient. Document all pertinent information in the appointment area of the order. Perform clerical work using various applications.

Minimum Requirements:

• High school diploma or equivalent.
• Experience in healthcare insurance verification and billing protocols.
• Two years' experience in face to face and/or customer service or equivalent field.
• Working knowledge of medical terminology, CPT codes, and ICD10 codes.
• Working knowledge of Microsoft Office products.
• Ability to type 30 wpm.
• Communication and customer service skills required to gather and exchange information with patients, families, hospital staff members, physicians and third party payers.
• Ability to work and think independently, ability to handle sensitive information, with discretion, attention to detail, ability to handle multi-tasking and change in priorities.

Preferred Qualifications:

Experience in authorization of outpatient procedures. Course work in medical terminology and coding.