Surgical & Clinical Care Coordinator – CPT & Authorization Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Review physician orders for surgical interventions, diagnostic assessments, therapy sessions, or clinical services.

• Validate and align orders with CPT/HCPCS codes and ICD-10 diagnoses prior to submission.

• Initiate, monitor, and obtain insurance prior authorizations based on CPT codes and clinical necessity guidelines.

• Manage inbound and outbound communications with insurance companies, healthcare providers, and patients.

• Address authorization inquiries, verify coverage policies, and handle peer-to-peer discussions or appeals as needed.

• Arrange surgical procedures, pre-operative evaluations, and clinical follow-ups following authorization approval.

• Coordinate surgery schedules, facility block times, and physician availability.

• Assist patients with pre-procedure instructions, necessary medical clearances, and appointment details.

• Maintain records of authorizations and scheduling within the practice’s EHR/EMR system.

• Oversee pending orders to avoid delays between physician order placement and final patient scheduling.

⛳️ Requirements

• A formal education or background in Nursing (RN/LPN/BSN), Physical Therapy (PT/PTA), or Podiatry.

• Proven ability to accurately interpret physician orders, identify CPT codes, and ensure compliance with payer authorization guidelines.

• Demonstrated experience in managing surgical scheduling, pre-testing protocols, and care navigation.

• Strong hands-on expertise in securing prior authorizations across a variety of insurance payers.

• Exceptional English communication skills for engaging with insurance representatives, coordinating with physicians' offices, and providing empathetic support to patients.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment that values teamwork and collaboration.