Prior Authorization Spec. / Financial Counselor- Texas Orthopedics

ORTHOLONESTAR•Austin, TX

3d•$16 - $24•Onsite

About The Position

GENERAL JOB DESCRIPTION: Responsible for all insurance verifications, benefit documentation, referrals, preparing procedure estimates and authorization for assigned location(s)/doctor(s).

Requirements

High School diploma
Two year previous experience in a medical office setting
Previous experience with insurance benefit verification
Knowledge of medical and insurance terminology
Attention to detail
Ability to effectively communicate both orally and written
Ability to work in a fast paced environment
Must have adequate visual acuity to read, the ability to interpret and understand written material.

Responsibilities

Correct and update Registration Information to ensure accuracy in claims filing as identified in the patient account
Prepare estimates for all procedures, notify patients and collect prior to procedures for assigned doctor(s)
Consults with the appropriate provider to obtain clearance that treatment regimen is considered medically necessary before initiating request to the insurance plan.
Verifies eligibility and notifies appropriate parties if eligibility has termed.
Processes referrals as needed, based upon insurance plan.
Submits medical records, works with the provider on necessary documentation, if necessary, to obtain authorization.
Notifies clinical staff, related physician and supervisor of any delays in obtaining authorization.
Schedules Peer-to-Peer calls when necessary.
Communicates any issues with authorization to team lead and appropriate surgery coordinator.
Handle patient calls for assigned doctor(s) as necessary, responding within 24 hours.
Issue appropriate paperwork for accounts requiring adjustments, patient refunds and corrections when identified.
Obtain necessary referrals, document in Referral Management and attach referral in schedule/visit
Receives questions from Office Manager for time of service collection issues the manager cannot resolve with the patient
Work with RCM and Reception Manager to identify ways to increase efficiency in demographic entry
Other duties as assigned.