Prosthetics Insurance Specialist

Tennessee Oncology•Nashville, TN

About The Position

The Prosthetics Insurance Specialist provides in-person and telephone customer service, maintaining a high 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, supportive customer service. The position handles insurance verification and authorization, prosthetic billing and claims, denial research and appeals, patient follow-up, appointment scheduling, and administrative documentation. It requires knowledge of prosthetics medical terminology, electronic medical records, and confidentiality requirements under HIPAA.

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.
Ability to manage multiple priorities 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.
Call patients who have not been seen in six months or more for follow-up.
Verify insurance coverage, particularly prosthetics benefits.
Obtain information required for billing.
Maintain prosthetic-related Excel spreadsheets accurately.
Schedule MD justification appointments and manage clinic schedules.
Reschedule cancelled or no-show 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.
Provide PSR coverage as needed, including assisting patients and scheduling appointments.
Perform other administrative duties as assigned.