Under general supervision, responsible for scheduling operating time of information systems operations in order to ensure that the information systems equipment is effectively utilized.

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• Excellent verbal and written communication skills; Bilingual (Spanish and English) preferred.
• Strong computer skills including Microsoft Word, Excel, PowerPoint and Outlook.
• Some medical experience.
• Previous surgery scheduling experience.
• Previous electronic medical record (EMR) experience.
• Knowledge of ICD-10 and CPT coding.

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•Minimum of three (3) years of surgery scheduling experience and Highschool OR GED.
•Experience supporting providers with high clinic volumes and large surgical caseloads.
•Extensive knowledge of insurance referral and authorization requirements for outpatient and inpatient surgeries.

Experience obtaining authorizations for:
-Surgical procedures
-Biologic grafts and skin substitutes

Experience using payer portals such as:
-Availity
-NaviNet
-Carelon
-Evicore
-UHC Provider Portal

•Knowledge of CPT, ICD-10, and HCPCS coding.
•Experience with electronic medical records (preferably Epic).

Knowledge, Skills, and Abilities
•Ability to manage a fast-paced workload supporting multiple surgeons with significant surgical volume.
• Strong understanding of orthopedic procedures, implants, grafts, and biologic products.
• Knowledge of insurance coverage requirements for grafts, skin substitutes, and specialty products used in clinic and surgery.
•Ability to navigate multiple insurance websites and portals to submit and track authorization requests.
•Strong organizational skills with the ability to prioritize urgent cases and meet payer deadlines.
•Excellent communication skills for coordinating with patients, providers, surgery centers, hospitals, and insurance representatives.
•Proficiency in Microsoft Office (Excel, Word, Outlook).
•High attention to detail and accuracy.

Key Job Duties
•Schedule orthopedic surgical procedures, injections, and related treatments for multiple high-volume providers.

Obtain and track referrals and prior authorizations for surgeries, grafts, biologic products.
•Verify insurance benefits and determine medical necessity requirements.
•Submit clinical documentation through insurance portals and follow up on pending requests.
•Coordinate pre-operative testing, medical clearances, and surgical facility requirements.
•Coordinate biologic grafts, skin substitutes, and specialty implants used in clinic and the operating room.
•Educate patients regarding surgical dates, financial responsibilities, and pre-operative/post-operative instructions.
•Communicate with hospitals, ambulatory surgery centers, vendor representatives, and insurance companies.
•Reconcile completed surgeries to ensure procedures, implants, and authorizations match services rendered.
•Assist with appeals and peer-to-peer reviews when authorizations are denied.
•Maintain accurate documentation in the electronic medical record.

Ideal Candidate Profile
The ideal candidate thrives in a fast-paced orthopedic environment, can independently manage complex insurance and authorization workflows, and is comfortable coordinating large surgical volumes while ensuring grafts.