About this role
ROLE AND RESPONSIBILITIES
- Verifies insurance eligibility and coverage case for all scheduled surgery patients.
- Obtains authorization / precertification for all scheduled surgeries.
- Coordinates with insurances and providers to schedule peer-to-peer when surgeries are not pre-approved.
- Obtains authorization / precertification for all custom braces (commercial insurances.)
- Obtains authorization / precertification for all L1833 knee braces (Medicare only.)
- Informs surgery patients of and coordinates collection for their financial responsibility, including deductibles, coinsurances, copays, etc.
- Communicates professionally and compassionately with patients and HIPAA-approved individuals to address their questions and concerns.
- Submits appeals for denied surgeries (VIVA only.)
- Maintains up-to-date knowledge of insurance laws, regulations, and guidelines.
- Answers and responds to phone calls and email communications.
- Serves as the primary point of contact for the practice and liaison between surgical patients, facilities, and physicians.
- Collaborates, and effectively communicates with other departments, insurance carriers, case managers, attorneys, and other pertinent parties to obtain approvals, facilitate the patient care, and claims process.
- Retrieves and scans missing information into patient's record prior to the patient's appointment, if needed.
- Reviews monthly unapplied money report to identify provider for corresponding visits and ensure totals balance.
- Performs all other duties as necessary and assigned by superiors.
QUALIFICATIONS
Behaviors & Motivations (Required)
- Exceptional customer-service provided to all customers, visitors, callers, and co-workers
- Professionally and compassionately communicates with others
- Good written communication skills
- Keen attention to detail amid changing priorities in a fast-paced environment
- Exceptional organizational and time-management abilities
- Maintains a positive attitude toward co-workers, management, and all providers
- Demonstrates initiative, dependability, and independent problem-solving abilities