Job Details

At OrthoVirginia, you're part of a team dedicated to delivering expert orthopedic and therapy care across the state. As Virginia's largest provider of musculoskeletal care, we offer full-time and part-time opportunities in a collaborative, team-oriented environment.

With more than 159 physicians in over 35 locations-including Lynchburg, Northern Virginia, Richmond, Southwest Virginia, and Hampton Roads-OrthoVirginia is a leader in orthopedic surgery, non-surgical care, and physical, hand, and occupational therapy. Our nationally recognized specialists treat a full range of musculoskeletal injuries and conditions, helping patients of all ages move, heal, and thrive.

Join us and become part of a trusted network committed to excellence in orthopedic care.

The Prior Authorization Specialist is responsible for processing and coordinating authorizations for various medical procedures, ensuring efficient and timely patient care. This role involves working closely with healthcare providers, insurance companies, and patients to facilitate authorizations and referrals for specialized treatments.

Primary Functions & Accountabilities:

• Obtain and process authorizations for surgery and procedures (excluding spine surgery), advanced imaging services, medications ordered, or electromyography (EMG) procedures.
  
• Communicate with healthcare providers, insurance companies, and patients to gather necessary information.
  
• Maintain accurate and up-to-date records of authorization requests and outcomes
  
• Follow up on pending authorizations and resolve any issues that arise.
  
• Communicate authorization details and follow-up procedures to patients, physicians or other relevant parties
  
• Ensure timely submission and tracking of authorization requests to minimize delays in treatment.
  
• Address any authorization-related issues that arise and follow up to resolve discrepancies.
  

Position Requirements:

• High school diploma or equivalent required; associate degree or healthcare-related certification preferred.
  
• Prior experience in medical referrals, authorization processing, or healthcare administration is highly desirable.
  
• Strong knowledge of insurance guidelines and authorization requirements for specialized treatments.
  
• Excellent communication and organizational skills.
  
• Ability to work efficiently in a fast-paced environment while maintaining attention to detail.
  
• Proficiency in medical terminology and healthcare systems/software.
  

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