Job Summary:MaineGeneral Health is seeking an experienced Authorization Review Specialist to ensure the accuracy of inpatient and outpatient surgery prior authorizations. In this vital role, you will collaborate closely with our medical staff and utilize your expertise in surgical documentation to ensure compliance with insurance authorizations. If you have a strong background in surgical coding and a keen eye for detail, we want to hear from you!

Job Description:

Key Responsibilities:

Review Surgical Documentation: Examine daily Operating Room surgical notes and compare them against procedural (CPT) codes and insurance authorizations to ensure alignment.Communicate with Insurance Providers: Contact insurance companies immediately to address any discrepancies or misalignments in surgical documentation.Ensure Proper Documentation: Verify that all necessary documentation is completed prior to daily surgical cases for inpatient surgeries.Provide Surgical Coding Support: Assist in surgical coding as needed, ensuring compliance and accuracy in documentation.

Qualifications:

Certification Required: Certification by the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) is required.Experience: A minimum of 2 years of experience in surgical authorization review, surgical coding, or a related healthcare role is highly preferred. Familiarity with prior authorization processes and insurance protocols is essential.Strong understanding of CPT coding and insurance authorization protocols.Excellent communication skills, with the ability to interact effectively with medical staff and insurance providers.Detail-oriented with strong analytical skills to ensure accuracy and compliance.

Scheduled Weekly Hours:40

Scheduled Work Shift:

Job Exempt: Yes

Benefits:

Supporting all aspects of our employees’ wellness – physical, emotional and financial – is a critical component of being a great place to work. With the wide range of benefits and programs available, employees have the resources they need to be well at every stage of life and plan for the future.

Physical Wellness:We offer quality health, dental, and vision benefits and wellness programs and resources to provide employees access to resources for a healthy lifestyle and help manage health care costs.Employees have access to industry-leading leave for new parents.A generous earned time plan is offered to all employees - We believe employees need and deserve time away from work to observe holidays, be with family, go on vacation, or simply take care of themselves.

Emotional Wellness:

When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household.

Financial Wellness:An employee discount program is available to all employees for services provided by MaineGeneral Medical Center.Tuition Reimbursement is available to all employees to further develop skills and career.We offer eligible employees up to 2% of eligible pay in 403(b) company-matching contributions plus another 2% in the 401(a) retirement income plan.Three insurance plans are available to protect your family from the sudden loss of income in the event of your death, terminal illness or serious injury from accident.We offer both short-term and long-term disability insurance to replace a portion of your income if you become disabled and cannot work for a period of time.

Career Mobility:

Helping our employees develop their skills and grow their careers is critical to how we retain our talent and sustain our business. We do this by offering our teammates a variety of leadership-supported programs and learning and development resources for every stage of their professional development. We know that our employees are our most valuable resource – they’re how we grow our business and care for our community.

Equal Opportunity Employer M/F/Vet/Disability  Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at (207) 861-3440 .