Surgery Scheduler and Authorization Coordinator

The Surgery Scheduler & Authorization Coordinator owns each surgical and procedural case from the provider's order to a cleared, confirmed date of service. The role schedules orthopedic surgeries and interventional pain and spine procedures at hospitals and ambulatory surgery centers, verifies benefits, secures prior authorizations, and makes sure patients arrive informed, cleared, and financially prepared. Success means no case is cancelled or denied for a missing authorization, clearance, or scheduling error.

Essential Duties: Surgery Scheduling & Facility Coordination

• Receive surgical and procedure orders from providers and confirm each is complete: CPT and ICD-10 codes, laterality, procedure description, anesthesia type, estimated case length, and implant or equipment needs.
• Schedule cases at the appropriate site of service (hospital, ambulatory surgery center, or in-office procedure suite) based on payer requirements, provider block time, and patient medical needs.
• Book cases with outside facilities, including hospital and surgery center scheduling offices, and submit booking packets (orders, H&P, consents, demographics, insurance, authorization numbers) by each facility's deadline.
• Maintain surgeon and procedure block schedules; release unused block time on time and fill openings from waitlists.
• Coordinate vendor and implant representatives, DME, and special equipment for cases that require them.
• Arrange pre-operative requirements: pre-admission testing, labs, imaging, EKG, and medical or cardiac clearance from primary care or specialists; track each item to completion before the date of service.
• Manage reschedules, cancellations, and add-ons; notify facilities, vendors, and patients, and update authorizations when dates, codes, or sites change.
• Keep all scheduling, authorization, and communication records current in the practice EMR (eCW current; athenahealth in future) and any facility tracking tools.
• Run a daily and weekly case-readiness review (T-7 and T-2 days) confirming authorization, clearance, consents, and financial clearance for every scheduled case.

Essential Duties: Insurance Verification & Prior Authorization

• Verify eligibility and benefits for every scheduled case through payer portals, clearinghouses, and phone: active coverage, network status for surgeon and facility, deductible, coinsurance, out-of-pocket maximum, and site-of-service rules.
• Determine prior authorization and pre-certification requirements by payer, CPT code, and site of service, including Medicare, Medicare Advantage, commercial, and radiology benefit managers.
• Prepare and submit authorization requests with supporting clinical documentation: office notes, imaging reports, failed conservative treatment history (physical therapy, medications, injections), and functional limitations.
• Track every authorization to a final decision; follow up on pending requests on a set schedule and document reference numbers, approved codes, units, date ranges, and facility.
• Coordinate peer-to-peer reviews between providers and payer medical directors, and prepare the case summary the provider needs.
• Initiate appeals and reconsiderations for denials, working with providers and billing on letters of medical necessity.
• Obtain authorizations for workers' compensation cases from the carrier or adjuster, and confirm claim number, body part, and approved treatment.
• Verify case details for personal injury and motor vehicle accident patients, including PIP coverage, attorney information, and a signed letter of protection or lien, in coordination with the medico-legal department.
• Prepare good-faith cost estimates for patients, including self-pay and uninsured patients as required under the No Surprises Act, and flag cases needing financial counseling or deposits.
• Maintain a current payer requirements reference and alert leadership to policy changes that affect scheduling or reimbursement.