Prosthetics Insurance Specialist

OneOncology•Nashville, TN

About The Position

The Prosthetics Insurance Specialist provides in-person and telephone customer service while maintaining a superior standard of patient experience. The role also provides coverage for the PSR position as needed, including assisting patients and scheduling appointments. Because prosthetic care can be a stressful time for patients, the specialist is expected to provide confident, excellent customer service. The position handles prosthetics insurance verification and billing documentation, claims, authorizations, reconsiderations, appeals, and denials. It also coordinates patient follow-up and justification appointments, maintains prosthetic-related records and spreadsheets, supports clinic scheduling, and performs administrative tasks. The role requires protecting patient confidentiality in accordance with HIPAA guidelines.

Requirements

High school diploma or GED.
At least 2 years of customer service experience.
Prosthetics medical terminology.
Experience with electronic medical records.
Ability to maintain confidentiality according to HIPAA guidelines.
Knowledge of insurance verification and authorization processes.
Knowledge of prosthetic billing requirements, including HCPCS coding.
Strong customer service and communication skills.
Strong attention to detail and organizational skills for managing documentation, researching claim denials, and maintaining patient records.
Ability to manage multiple priorities, including scheduling, follow-up, and administrative coordination in a fast-paced environment.
Proficiency in EMR systems, Microsoft Office applications, and data tracking tools.

Nice To Haves

Medical office experience.
Excellent verbal and written communication skills.

Responsibilities

Generate RX/CMN forms from superbills using HCPCS coding.
Submit documentation to obtain precertification, reconsiderations, or appeals when necessary.
Create and submit insurance claims using HCPCS coding.
Identify, understand, and work to overturn insurance denials.
Conduct phone follow-ups with patients who have not been seen in six months or more.
Verify insurance coverage, with particular attention to prosthetics benefits.
Obtain information required for billing.
Maintain prosthetic-related Excel spreadsheets accurately.
Schedule MD justification appointments and manage clinic schedules.
Reschedule cancelled or missed justification appointments as needed.
Scan patient records into the EMR system.
Submit orders for Physical Therapy services.
File patient data promptly upon receipt.
Perform data entry, copying, faxing, and emailing as required.
Provide coverage for the PSR position as needed, including assisting patients and scheduling appointments.
Perform other administrative duties as assigned.