Surgical Authorization Specialist

JOB TITLE : Surgical Authorization Specialist

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SUMMARY : The Surgical Authorization Specialist at Progressive Spine & Orthopaedics is responsible for securing and managing surgical authorizations, with a focus on complex cases involving Motor Vehicle Accidents (MVA), Workers’ Compensation (WC), and Personal Injury Protection (PIP).

This role requires strong knowledge of out-of-network processes, legal documentation requirements, and payer-specific regulations. The Surgical Authorization Specialist works independently to navigate multi- party communications between insurance carriers, attorneys, adjusters, and healthcare providers to ensure timely approvals and accurate records, helping to prevent surgical delays.

DUTIES AND RESPONSIBILITIES :

• Obtain surgical authorizations for cases involving out-of-network carriers, WC, MVA and PIP, ensuring compliance with state regulations and carrier requirements.
• Review and compile necessary clinical and legal documentation, including letters of medical necessity, operative notes, accident reports, and attorney requests.
• Communicate regularly with attorneys, adjusters, and case managers to secure required approvals and resolve documentation gaps.
• Track and follow up on pending authorizations to avoid delays in surgery scheduling.
• Navigate unique or complex payer situations, such as multiple insurance carriers or disputed

claims.

coordinating with physician for peer-to-peer reviews when needed.

communicated and any delays are addressed proactively.

QUALIFICATIONS :

GENERAL EXPECTATIONS :

authorizations.

pressure.

COMPENSATION :

Pay based on experience and qualifications

In accordance with the New Jersey Pay Transparency Act, this position falls within Pay Grade 7 of the 2025 OPM Salary Table for the NY, NJ, CT, and PA region.

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