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Ophthalmic Surgical Auth Coordinator
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Munster Eye Care Associates, P.C.
Munster, IN (In Person)
$37,440 Salary, Full-Time
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Job Description
Position Summary The Ophthalmology Surgery Authorization Specialist is responsible for obtaining and managing insurance authorizations for ophthalmic surgical procedures, ensuring accurate documentation, timely approvals, and compliance with payer requirements. This role works closely with surgeons, surgical schedulers, clinical staff, insurance companies, and patients to coordinate pre-certification and financial clearance for procedures. Key Responsibilities Obtain prior authorizations and pre-certifications for ophthalmology surgical procedures. Verify patient insurance eligibility, benefits, referrals, and authorization requirements. Submit clinical documentation to insurance carriers for medical necessity review. Follow up on pending authorizations and resolve denied or incomplete requests. Coordinate surgery scheduling with physicians, surgery centers, hospitals, and patients. Communicate authorization status, financial responsibilities, and scheduling updates to patients. Maintain accurate records in the electronic medical record (EMR) and practice management systems. Ensure compliance with payer policies, Medicare guidelines, HIPAA, and organizational procedures. Review CPT, ICD-10, and HCPCS codes related to ophthalmology surgeries. Work collaboratively with billing and coding departments to reduce claim denials. Monitor authorization expiration dates and ensure approvals remain valid prior to surgery. Assist with appeals and reconsiderations for denied authorizations. Maintain knowledge of ophthalmology procedures, insurance regulations, and payer updates. Qualifications Required High school diploma or equivalent Minimum 3 years of prior authorization, medical scheduling, or insurance verification experience Knowledge of medical terminology, insurance plans, and authorization processes Experience with EMR and practice management systems Strong organizational and communication skills Ability to multitask in a fast-paced medical office environment Experience with Medicare, Medicaid, and commercial payers Preferred Experience in ophthalmology or surgical specialty practice Knowledge of CPT, ICD-10, and HCPCS coding Certified Professional Coder (CPC) or related certification (obtained within 1 year of employment)