Authorization and Eligibility Representative

OrthoArizona•Mesa, AZ

About The Position

About OrthoArizona: At OrthoArizona, we are bringing the best together. Our organization was created to help serve ALL orthopedic and podiatry needs throughout the Valley! We have a wide range of orthopedic surgeons and mid-level providers including physical and occupational therapists. Today we are one of Arizona’s largest privately owned and most comprehensive orthopedic practices with more than 75 locally and nationally renowned providers across 30 locations, in addition to 2 ambulatory surgical centers and in house state of the art MRI capabilities. At OrthoArizona we are committed to best-in-class patient care, being a pioneer in research and technology, and most importantly, rewarding and recognizing our employees. As an Authorization & Eligibility Representative with OrthoArizona, you will get to: Verify insurance coverage for potential new patients, add Ons, and re-verify insurance coverage for existing patients. Navigate through multiple insurance portals or by phone to obtain necessary insurance benefits. Reconciles obtained information within the Practice Management System, EMR, and Phreesia to ensure successful claim processing. Responsible for obtaining all referrals and authorizations for Physical Therapy Patients, as required. Responsible for acting as a liaison between patients, healthcare providers, and insurance carriers to ensure all proper measures are taken and information is collected. Enter any authorization numbers and expiration dates into the Practice Management System, EMR, and Phreesia for proper claim processing. Update pertinent insurance notes in multiple EMR systems for corresponding departments to access. Maintain medical records in accordance with practice policies and procedures. Using state or federally regulated websites may require personal login credentials.

Requirements

Excellent customer / patient service.
Knowledge of medical terminology.
Working knowledge of computer programs.
Excellent written and verbal communication skills.
Understand/Perform training on practice management software.
Ability to promote favorable facility image with physicians, patients, insurance companies, and general public.
Ability to communicate effectively on the telephone.
Ability to make decisions and solve problems.
Working knowledge of health insurance plans including reading plan requirements.
Follow all Standard Operating Procedures.
High School diploma or GED.
Minimum of 2 years of experience in healthcare administration or related field.
Strong organizational and communication skills.
Ability to work independently and as part of a team.
Ability to meet metric deadlines and stay within goal expectations with little oversight.
Knowledge of medical terminology and insurance authorization processes.

Nice To Haves

Centricity Software and Phreesia Experience

Responsibilities

Verify insurance coverage for potential new patients, add Ons, and re-verify insurance coverage for existing patients.
Navigate through multiple insurance portals or by phone to obtain necessary insurance benefits.
Reconciles obtained information within the Practice Management System, EMR, and Phreesia to ensure successful claim processing.
Responsible for obtaining all referrals and authorizations for Physical Therapy Patients, as required.
Responsible for acting as a liaison between patients, healthcare providers, and insurance carriers to ensure all proper measures are taken and information is collected.
Enter any authorization numbers and expiration dates into the Practice Management System, EMR, and Phreesia for proper claim processing.
Update pertinent insurance notes in multiple EMR systems for corresponding departments to access.
Maintain medical records in accordance with practice policies and procedures.
Using state or federally regulated websites may require personal login credentials.