Surgical Prior Authorization Coordinator III

Position Description:

As the Surgical Prior Authorization Coordinator III in Orthopaedic Surgery you will be responsible for managing the process of securing prior authorizations for surgical procedures and services. This role involves assigning or verifying CPT codes based on provider documentation, verifying insurance coverage, coordinating with healthcare providers, and communicating with insurance companies to ensure that patients receive the necessary approvals for their surgical treatments.

Primary Functions

• Assign and/or verify CPT, ICD-10 CM coding, and modifiers based upon provider documentation.
• Keep coding and documentation resources for the providers and surgery schedulers updated on a continuous basis.
• For clinical procedures and special handle procedures:
  • Initiate and manage the process of obtaining prior authorizations from insurance companies.
  • Ensure that medical necessity requirements are met and work with healthcare providers to gather necessary documentation.
  • Collaborate with healthcare providers, insurance companies, and patients to facilitate the authorization process and address any issues or discrepancies.
  • Manage departmental drug inventory and distribution.
  • If a surgical authorization is denied, work with clinical team as needed.
  • Stay updated on relevant regulations and insurance policies to ensure compliance with all guidelines.
  • Identify and report trends in surgical authorization denials and work with the Sr. Reimbursement Manager to implement quality improvement measures.
  • Collaborate with surgical schedulers and healthcare providers to ensure that scheduled surgeries align with approved authorizations.
  • Provide patients with information about the prior authorization process and their financial responsibilities, answering any questions or concerns.
  • Provides assistance, training, and/or coverage to other team members as needed, acts as valuable resource for all surgeons and APPs in the Department.

Knowledge - Skills - Abilities

• Previous experience in healthcare administration, medical billing, or revenue cycle management.
• Knowledge of surgical procedures, medical terminology, and the surgical authorization process.
• Strong communication and interpersonal skills.
• Attention to detail and the ability to work in a fast-paced, deadline-driven environment.
• Knowledge of insurance verification processes and healthcare compliance regulations.
• Familiarity with electronic health record (EHR) systems.
• Coding experience related to surgical procedures or coding certification (CPC, CPC-A, CCS-P, CCA, RHIT, or RHIA)

Preferred Schedule:

Position Requirements:

Appropriate experience may be substituted for education on an equivalent basis

Minimum Required Education: High School Diploma
Minimum Required Experience: 4 years, with prior authorization and coding related to surgical procedures.
Certification: Coding certification preferred

Why MCW?

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
• 403B Retirement Package
• Competitive Vacation and Paid Holidays offered
• Tuition Reimbursement
• Paid Parental Leave
• Pet Insurance
• On campus Fitness Facility, offering onsite classes.
• Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.

For a full list of positions see: www.mcw.edu/careers

For a brief overview of our benefits see: https://www.mcw.edu/departments/human-resources/benefits

Eastern Wisconsin is a vibrant, diverse metropolitan area. MCW is intent on attracting, developing, and retaining a diverse workforce and faculty body that reflects the community we serve. We value diversity of backgrounds, experience, thought, and perspectives to advance excellence in science and medicine. MCW is a welcoming campus community with a strong culture of collaboration, partnership, and engagement with our surrounding community. For more information, please visit our institutional website at https://www.mcw.edu/departments/office-of-diversity-and-inclusion.

MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination


The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering a diverse community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.

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