Overview:

We are seeking a dedicated and detail-oriented Workers Compensation & Surgical Authorization Specialist to join our team!

This role involves managing workers' compensation claims and securing surgical authorizations, ensuring seamless coordination between healthcare providers, insurance companies, and patients. The ideal candidate will possess a strong understanding of health insurance policies, medical coding, and authorization processes, with a commitment to maintaining confidentiality and delivering exceptional customer service. This position offers an opportunity to contribute to efficient healthcare operations while supporting patient care and organizational compliance.

Responsibilities:

Review and process workers' compensation claims, verifying coverage and ensuring timely resolution of authorization requests. Obtain prior authorizations for surgical procedures by coordinating with insurance carriers, physicians, and patients to facilitate approval. Utilize CPT coding, ICD-9, ICD-10, and ICD coding systems accurately to document diagnoses and procedures in accordance with medical billing standards. Maintain comprehensive medical records and ensure compliance with HIPAA regulations and clinical confidentiality policies. Communicate effectively with healthcare providers, insurance companies, and patients regarding authorization status, documentation requirements, and claim updates. Manage electronic health records (EHR) systems efficiently for tracking authorization requests, approvals, denials, and related correspondence. Ensure adherence to managed care protocols and health insurance policy guidelines throughout the authorization process. Provide exceptional customer service by addressing inquiries promptly and professionally while maintaining detailed documentation of all interactions.

Qualifications:

Proven experience in medical office administration or healthcare support roles with a focus on workers' compensation or surgical authorization processes. Strong knowledge of health insurance policies, managed care practices, and prior authorization procedures. Familiarity with medical terminology, medical coding (CPT, ICD-9, ICD-10), medical billing, and insurance verification processes. Experience working with electronic health records (EHR) or electronic medical records (EMR) systems is essential. Excellent organizational skills with the ability to manage multiple cases simultaneously while maintaining accuracy. Demonstrated understanding of HIPAA regulations and clinical confidentiality policies to protect patient information.

Required:

High school diploma or

GED Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance 12 Holidays No weekends

Pay:

$27.00 - $29.00 per hour

Benefits:

401(k) Dental insurance Disability insurance Health insurance Life insurance Paid time off Retirement plan Vision insurance

Work Location:

Hybrid remote in Plymouth, MA 02360