What are the responsibilities and job description for the Prior Authorization Specialist - Financial Counselor position at Texas Orthopedics, a division of OrthoLoneStar?
**MUST RESIDE IN TEXAS, REMOTE POSITION AFTER ONBOARDING AND APPROVAL TO GO REMOTE**
GENERAL JOB DESCRIPTION: Responsible for all insurance verifications, benefit documentation, referrals, preparing procedure estimates and authorization for assigned location(s)/doctor(s).
ESSENTIAL FUNCTIONS:
QUALIFICATIONS
Experience:
Licensure:
Special Skills:
Physical Demands:
Environmental Working Conditions:
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 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.
QUALIFICATIONS
Education: High School diploma
Experience:
- Two year previous experience in a medical office setting
- Previous experience with insurance benefit verification
Licensure:
Special Skills:
- 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
Physical 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.
