Overview:
The Surgical Estimator is responsible for preparing accurate surgical cost estimates prior to ophthalmic surgery, including expected patient out-of-pocket responsibility and elective upgrade costs. This role supports the surgical scheduling team by ensuring financial information is complete, accurate, and ready for patient-facing discussions. While the Surgical Estimator does not serve as the primary patient contact, they play a critical role in enabling schedulers to communicate confidently and consistently with patients regarding surgical costs. The Surgical Estimator supports pre-service collections by following up with patients who have outstanding balances prior to surgery, ensuring financial readiness ahead of the scheduled date of service.
Key Responsibilities:
Verify insurance benefits related to scheduled surgical procedures, including deductible, coinsurance, copay, and out-of-pocket maximum
Calculate anticipated patient financial responsibility for professional and facility components
Prepare elective upgrade pricing and supporting documentation when applicable
Ensure estimates are completed and documented prior to patient scheduling conversations
Maintain accurate and consistent estimate documentation within the EHR or designated tracking system
Confirm that required surgical authorizations have been obtained and are valid prior to date of service
Confirm pre-service payment status and facilitate resolution of unpaid balances in accordance with practice policy
Partner closely with referral and surgical scheduling teams to ensure financial and authorization readiness prior to surgery.
Serve as an internal escalation point for complex estimate or authorization discrepancies
Identify recurring early payer issues, estimate variances, or workflow gaps and communicate trends to leadership
Participate in performance reviews and continuous improvement initiatives.
Assist with development and maintenance of standardized estimate templates and readiness checklists
Track referral volumes, trends, and common issues.
Support physicians by anticipating needs and resolving referral or estimate-related issues proactively.
Qualifications:
High school diploma or equivalent
Experience in medical insurance verification, referrals, surgical intake, or financial estimation
Proficiency with EHR systems and standard office software
Experience in ophthalmology or optometry
Excellent organizational, communication, and problem-solving skills
Strong understanding of insurance verification, referrals, and authorizations
Job Details: