Insurance Specialist - Referral / Authorization
Company: The Orthopedic Clinic of Daytona Beach
Location: Daytona Beach
Posted on: September 6, 2018
The Orthopedic Clinic is a leader in the orthopedic community of East Central Florida. Our team is dedicated to providing compassionate and cutting-edge orthopedic care. We believe every patient should receive the best possible care, our practice offers an array of services specializing in general orthopedics, spine care, sports reconstruction, adult reconstruction and non-surgical treatments. The Orthopedic Clinic is a well-respected practice that was established in 1961 and has a rich history of providing exceptional Orthopedic care to the community. We currently have nine Orthopedic Surgeons, seven Mid-Level Providers, and a Physical Therapy team who serve patients at four locations within Volusia and Flagler counties.The position will be accountable for verifying eligibility and benefits, securing Authorization for services and coordinating with clinics and patients to address payor authorization issues. POSITION EXPECTATIONS:--- Performs insurance verification and obtains initial and subsequent preauthorization for services, including procedures, surgeries, medication, injectable, imaging and DME. --- Submits, processes, tracks, and follows up on all referrals requested by providers in a timely fashion.--- Performs insurance verification and benefit check for all patients prior to scheduling --- Manage Orders submitted to Imaging Facilities and outside Referral Networks and obtain prior authorization as needed. --- Manage Orders submitted to Specialty/Local Pharmacy and obtain prior authorization as needed. --- Communicates with physicians and department staff when there are issues with authorization--- Knowledge of the principles and practices of physician billing, out of network benefits, collection administration, industry and government regulations and reimbursements.--- Contacts insurance companies via phone and/or web to verify clients medical benefits and provides Insurance with basic clinical information in patients chart to justify medical necessity.--- Knowledge in CPT and ICD-9/10 codes is a must. Knowledge of the processes to perform reviews and attain payment status for state insurance carriers utilizing the telephone and internet--- Skill in exercising a high degree of initiative, judgement, discretion, and decision-making to achieve organizational objectives--- Skill in establishing and maintaining effective working relationships with employees, policy-making bodies, third party payors, patients and the public--- Clearly and accurately documents all correspondence regarding an account --- Assist Patient Services staff with patients requesting advanced assistance --- Reading and comprehending explanation of benefits/HCFA forms--- Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims, and generally accepted insurance benefit terms and processes--- Covers for other billing office employees, as needed .
--- Demonstrates a commitment to producing the highest quality work to the position, while utilizing the philosophy of continuous performance improvement--- Strives to do the job right the first time--- Provides superior customer service in a professional, compassionate and friendly manner--- Listens to internal and external customers and answers all questions promptly, completely and professionally --- Desire to work in a team oriented environment and support the physicians, mid-level providers, leadership, fellow employees and other departments by helping out wherever needed with a positive attitude--- Maintains professionalism in speech, actions and attire--- Upholds the confidentiality of our patients, associates and proprietary company informationREQUIRED KNOWLEDGE, SKILLS AND ABILITIES:--- Must possess strong Accounts Receivable Claims Appeals and collections skills, basic understanding of the guidelines; be organized, able to prioritize tasks. --- Willing to do follow up on accounts receivables including but not limited to specialties ofphysical therapy, chiropractic, pain management, internal medicine and orthopedic practices. --- Strong understanding of customer service and the administrative operations of a medical practice--- Working knowledge of medical terminology, medical insurance and medical billing --- Possess exceptional communication, interpersonal, and organizational skills --- Ability to work independently, as well as, in a team setting--- Ability to work in a fast-paced environment with a variety of personalities and work styles--- Ability to be flexible in schedule and adaptable to constant change--- Ability to evaluate and make recommendations for continuous improvementsREQUIRED QUALIFICATIONS:--- Minimum of High School Diploma --- Previous customer service experience, preferably in medical/healthcare setting --- Proficiency in the use of Microsoft Office Products, EPM and EHR software applications, preferably Athena--- Must be able to proficiently speak, read and write in English--- Valid Drivers License--- Clean Driving Record--- Proof of auto insuranceTOC is an equal opportunity affirmative action employer and administers all personnel practices without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity or expression, marital status, veteran status, genetics or any other category protected under applicable law.PM18 PI103851157
Keywords: The Orthopedic Clinic of Daytona Beach, Daytona Beach , Insurance Specialist - Referral / Authorization, Other , Daytona Beach, Florida
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