Position Summary
Lake Martin Family Medicine is seeking a professional, organized, and detail-oriented Receptionist / Prior Authorization Specialist to join our surgical clinic team. This position is responsible for providing excellent front-office support while also managing insurance verification and prior authorization processes for surgical procedures, diagnostic testing, and other services.
The ideal candidate will have strong communication skills, excellent attention to detail, the ability to multitask in a fast-paced medical environment, and a commitment to providing a positive experience for patients.
This position requires travel between clinic locations as needed. Mileage incurred while traveling between locations for work-related purposes will be reimbursed in accordance with the clinic’s mileage reimbursement policy.
Essential Responsibilities
Reception / Front Office
- Greet patients and visitors in a professional and welcoming manner.
- Answer and route incoming phone calls and respond to patient inquiries.
- Schedule, confirm, and reschedule patient appointments and surgical procedures.
- Check patients in and out and collect applicable copays, deductibles, and balances.
- Obtain and update patient demographic, insurance, and contact information.
- Maintain accurate patient records and documentation in the electronic medical record (EMR).
- Communicate appointment and procedure instructions to patients.
- Coordinate communication between patients, providers, surgery centers, hospitals, and other healthcare facilities.
- Maintain confidentiality of patient information in accordance with HIPAA and clinic policies.
Insurance Verification & Prior Authorization
- Verify patient insurance eligibility and benefits prior to appointments and procedures.
- Obtain prior authorizations for surgeries, procedures, diagnostic testing, medications, and other services as required.
- Submit authorization requests through insurance portals, fax, phone, or other designated systems.
- Monitor authorization requests and follow up with insurance companies regarding pending or incomplete requests.
- Document authorization numbers, approval dates, denial information, and other pertinent details in the patient’s record.
- Identify insurance requirements, referrals, pre-certifications, and medical documentation needed for authorization.
- Communicate with clinical staff regarding authorization requirements and missing documentation.
- Notify providers and appropriate staff of authorization approvals, denials, or additional requirements.
- Assist with appeals or reconsideration requests when necessary.
- Ensure authorizations are obtained within required timeframes to prevent delays or cancellations.
- Maintain organized records of pending and completed authorizations.
- All other duties as assigned.
Travel Between Locations
- Travel to other clinic or surgical office locations as assigned.
- Provide reception, scheduling, insurance verification, prior authorization, and administrative support at alternate locations.
- Maintain the same level of professionalism, confidentiality, and productivity at each location.
- Maintain reliable transportation and a valid driver’s license, if required by the clinic.
- Mileage for approved work-related travel between locations will be reimbursed according to the clinic’s current mileage reimbursement policy.
Qualifications
- High school diploma or equivalent required.
- Previous experience in a medical office, surgical practice, physician office, hospital, or healthcare setting preferred.
- Prior experience with insurance verification and prior authorizations strongly preferred.
- Familiarity with medical terminology and insurance terminology.
- Experience working with electronic medical records and insurance portals preferred.
- Strong computer and data-entry skills.
- Excellent verbal and written communication skills.
- Strong organizational skills and attention to detail.
- Ability to prioritize multiple tasks and meet deadlines.
- Ability to work independently while also functioning effectively as part of a healthcare team.
- Professional, dependable, and patient-focused demeanor.
Preferred Experience
- Surgical scheduling experience.
- Orthopedic, general surgery, ENT, ophthalmology, pain management, or other procedural/specialty clinic experience.
- Experience obtaining authorizations from commercial insurance companies and/or government payers.
- Knowledge of CPT and ICD-10 coding and how they relate to authorization requirements.
Physical & Work Requirements
- Ability to sit and work at a computer for extended periods.
- Ability to communicate effectively by telephone and in person.
- Ability to travel between assigned clinic locations as needed.
- Ability to maintain a professional and courteous demeanor in a busy clinical environment.
- Reliable attendance and punctuality are essential.
Key Attributes
The successful candidate will be:
- Organized and detail-oriented
- Dependable and flexible
- Patient-focused
- Comfortable communicating with insurance companies
- Able to manage competing priorities
- Proactive in following up on pending authorizations
- Professional and compassionate
- Comfortable traveling between clinic locations when needed
Position Expectations
This position plays an important role in ensuring that patients receive timely care and that surgical procedures are properly scheduled and authorized. The Receptionist / Prior Authorization Specialist is expected to maintain accurate documentation, communicate effectively with patients and insurance companies, protect patient confidentiality, and support the overall efficiency of the surgical clinic.