Surgery Center Benefits Coordinator in Peachtree City, Georgia at Med Management LLC

Surgery Benefits Specialist

Peachtree City, GA

Description

The Surgery Benefits Specialist is responsible for verifying surgical insurance benefits, reviewing patient coverage, identifying authorization and referral requirements, and ensuring accurate financial information is obtained prior to surgery. This position plays a key role in supporting a clean billing process, reducing claim denials, and helping patients understand their estimated financial responsibility before surgical services are provided.

All employees are expected to exhibit professional, ethical, and respectful behavior in accordance with the company’s mission, vision, and values.

Essential Functions

Verify surgical insurance eligibility and benefits for upcoming procedures by utilizing insurance carrier websites, portals, or by contacting insurance carriers directly.

Review and document deductible, coinsurance, copay, out-of-pocket maximum, and remaining patient responsibility information.

Confirm whether deductible must be met prior to benefits applying.

Verify CPT codes, diagnosis codes, place of service, facility participation, and provider participation when applicable.

Determine if prior authorization, predetermination, PCP referral, or insurance-approved referral is required for scheduled surgical procedures.

Communicate authorization and referral requirements to the appropriate team members in a timely manner.

Accurately enter surgery benefit information into the billing system, spreadsheets, or designated tracking tools.

Review surgical worksheets and schedules to ensure all required benefit information has been obtained prior to the surgery date.

Identify and communicate insurance-related issues, including out-of-network benefits, inactive coverage, missing referrals, authorization concerns, or potential patient financial liability.

Coordinate with surgery schedulers, front office staff, call center staff, authorization team members, and billing staff to resolve insurance or scheduling discrepancies.

Assist staff with understanding insurance carrier websites, benefit verification requirements, and surgery benefit processes.

Answer questions from patients, staff, and insurance companies regarding surgical benefits and coverage.

Support clean billing by ensuring accurate insurance, benefit, referral, and authorization information is documented before surgery.

Maintain patient demographic and insurance information as needed.

Participate in the development and communication of standard operating procedures to improve accuracy, consistency, and understanding of surgery benefit workflows.

Participate in educational activities and attend staff meetings as required.

Maintain strict confidentiality and adhere to all HIPAA guidelines and regulations.

Perform miscellaneous job-related duties as assigned.

Competencies

Strong understanding of medical insurance benefits and surgical benefit verification

Knowledge of deductibles, coinsurance, copays, out-of-pocket maximums, referrals, and prior authorizations

Effective written and verbal communication skills

Strong attention to detail and accuracy

Ability to review CPT and diagnosis codes for benefit verification purposes

Teamwork oriented

Problem-solving skills

Initiative and accountability

Proficient computer and typing skills

Ability to navigate insurance carrier websites and portals

Ethical conduct and professionalism