Surgical & Clinical Care Coordinator - CPT & Authorization Specialist

About the Role

We are seeking a highly skilled Surgical & Clinical Care Coordinator with a clinical background in Nursing, Physical Therapy, or Podiatry. This role combines clinical knowledge with technical revenue cycle expertise—specifically reading physician orders, identifying correct CPT codes, securing prior authorizations, and coordinating end-to-end patient scheduling.

You will serve as the primary engine translating doctor orders into authorized, scheduled procedures and care plans. You must be deeply comfortable navigating CPT/ICD-10 codes, fielding phone calls regarding authorization details, and guiding patients through their appointment and surgical schedules.

Requirements

Key Responsibilities

1. Doctor Order Processing & CPT Verification

• Review physician orders for surgical procedures, diagnostic tests, therapy sessions, or clinical services.
• Validate and match orders against correct CPT/HCPCS codes and ICD-10 diagnoses to ensure complete coding accuracy before submission.

2. Prior Authorization Management & Phone Support

• Initiate, track, and secure insurance prior authorizations based on specific CPT codes and clinical necessity guidelines.
• Answer inbound and place outbound phone calls to insurance companies, medical providers, and patients to resolve authorization inquiries, verify coverage rules, and address peer-to-peer or appeal requirements.

3. Surgical & Appointment Coordination

• Contact patients directly to schedule surgical procedures, pre-operative testing, and clinical follow-ups once authorizations are approved.
• Coordinate surgery times, facility block times, and physician calendars.
• Walk patients through pre-procedure instructions, required medical clearances, and appointment logistics over the phone.

4. Documentation & EHR Workflow

• Maintain meticulous records of authorization numbers, expiration dates, approved CPT codes, and scheduling updates within the practice EHR/EMR system.
• Monitor pending orders to ensure zero delays between physician order placement and final patient scheduling.

Qualifications & Requirements

• Clinical Background (Required): Formal education or background in Nursing (RN/LPN/BSN), Physical Therapy (PT/PTA), or Podiatry.
• CPT & Coding Knowledge: Demonstrated ability to accurately read doctor orders, identify CPT codes, and align them with payer authorization rules.
• Surgical & Care Coordination: Proven experience managing surgical scheduling, pre-testing requirements, and care navigation.
• Prior Authorizations: Strong hands-on background securing prior auths across various insurance payers.
• Phone Communication: Excellent, articulate English speaking skills for calling insurance reps, coordinating with doctors' offices, and speaking empathetically with patients.

Originally posted on Himalayas