Surgical Representative

Serves as a liaison for the OMFS interns, residents, and fellows by providing insurance guidelines, authorizations, and support for clinic patients requiring surgery.

Reviews surgical procedures with doctor to make CPT and ICD coding recommendations.

Verifies patient eligibility and benefits, and obtain pre-authorization, if required, for surgery.

Utilizes HCPCs codes to secure authorization for nutritional supplements, medications, or other items, deemed medically necessary, for an effective recovery for the patient.

Effectively communicates with patient registration desk, utilization management, nurses and medical director to give all pertinent clinical documentation as required to secure the surgical authorization.

Tracks status of pending pre-certifications and pre-authorizations, keeping the providers informed of status. Maintains and updates notes on the Authorization Status Report for all team members to access information, as needed.

Informs prospective surgery patients of insurance coverage and their financial responsibility. Utilizes surgical authorization form for patient to sign reflecting insurance benefits, patient responsibility, and establishing payment plans as necessary.

High school diploma or GED required.

Five (5) years of experience performing a full range of clerical support services that includes medical terminology, required.

Experience identifying and using ICD -10 and CPT codes required.

Physical Demands: Standing, sitting, walking, talking or hearing. No special vision requirements. Ability to lift or exert up to 25 lbs.

Work Environment: Office and Clinical environment. Moderate Noise.