Texas Orthopedics, a division of OrthoLoneStar

Prior Authorization Specialist - Financial Counselor

  • Texas Orthopedics, a division of OrthoLoneStar
  • Remote
  • 3 months ago

Job Description

**MUST RESIDE IN TEXAS, REMOTE POSITION AFTER TRAINING 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
:
  • 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.

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