What are the responsibilities and job description for the Prior Authorization Specialist - Financial Counselor position at OrthoLoneStar PLLC?
GENERAL JOB DESCRIPTION : Responsible for all insurance verifications, benefit documentation, referrals, preparing procedure estimates and authorization for assigned location(s) / doctor(s).
ESSENTIAL FUNCTIONS :
Correct and update Registration Information to ensure accuracy in claims filing as identified in the patient accountPrepare 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 / visitReceives questions from Office Manager for time of service collection issues the manager cannot resolve with the patientWork with RCM and Reception Manager to identify ways to increase efficiency in demographic entryOther duties as assigned.QUALIFICATIONS
Education : High School diploma
Experience :
Two year previous experience in a medical office settingPrevious experience with insurance benefit verificationLicensure :
Special Skills :
Knowledge of medical and insurance terminologyAttention to detailAbility to effectively communicate both orally and writtenAbility to work in a fast paced environmentPhysical Demands :
Must have adequate visual acuity to read, the ability to interpret and understand written material.Environmental Working Conditions :
Continuously handle multiple tasks simultaneously and work as a part of a team.No conditions of chemicals / fumes / odors and dust / messiness.
