Benefits:
Health insurance
Paid time off
Profit sharing
Vision insurance
401(k)
Company parties
Dental insurance
This position is responsible for ensuring medical criteria is met and obtaining timely authorization from insurance carriers to optimize revenue cash flow. Coordinates with schedulers prior to any procedures to obtain proper authorizations (i.e durable medical equipment, injections, surgeries, etc.). Maintains a working knowledge of our financial system and knowledge of insurance requirements. Responsible for collecting, reviewing, discussing and documenting demographic, insurance and financial information with patients and payers. Collect surgery deposit payments prior to surgery. Makes independent decisions that require individual and/or team analysis, reasoning, and problem solving. Accurately documents interactions and interprets interactions documented by others. Processes accounts and incoming payments in compliance with financial policies and procedures. Provides options for the uninsured or indigent patients (Credit card applications, County Assistance, payment arrangements, etc.) Performs other related duties as assigned.
Essential Job Functions:
Coordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage while ensuring meets medical criteria.
Able to triage incoming calls and requests from provider groups/patient for authorization of services, questions, status updates
Collect surgery deposits
Ensure professional communication with patients, clinic personnel, and outside vendors whether over the phone, via email or other written documentation and respond to all inquiries
Maintain a working knowledge of health care plan requirements and health plan networks
Verify and document insurance information as defined by current business practices
Accurately post all payments received from patients, attorney offices and/or insurance companies
Minimum Qualifications:
Essential Functions (Physical):
Regular and predictable attendance is an essential job function.
Majority of the shift is spent sitting.
Frequent reaching, stooping and twisting when filing, accessing records and answering telephone
Ability to lift up to 25 pounds.
Read a variety of printed and handwritten materials, computerized reports, manuals, and correspondence.
Communicates with patients, physicians, families and co-workers in person and on the telephone.
Comply with company policies, procedures, practices and business ethics guidelines.
Complete job required training.
Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
Work in the office during business hours
Work at an efficient and productive pace, handle interruptions appropriately and meet deadlines
Communicate and interact in a respectful and professional manner
Prioritize workload while being flexible to meet the expectations of the daily operations
Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions
Understand and execute a variety of instructions
Work independently with minimal supervision
Work Environment:
Orthopedic Surgery & Sports Medicine operates in a professional office environment. Days and hours of work are conducted Monday thru Friday 8:00 am to 5:00 pm.
This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Orthopedic Surgery & Sports Medicine has multiple locations and travel may be required.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.