Full Description

Orthopedic Specialists of SW Florida

Job Title: Insurance Verifications Representative

Department: Billing

Exempt Status: Nonexempt Position Status (FT/PT/PRN): Full Time

Reports To: Billing Director Supervises: N/A

Job Summary: Oversee all patient authorizations and related verifications of insurance, procedure eligibility/coverage and patient benefit plan information. This position has unrestricted access to protected health information (PHI) pertaining to all patients.

Essential Functions

Receive patient information, calls or accesses website resources in respect to carrier documentation Obtain insurance verifications and authorizations from insurance companies via telephone, facsimile or online program Obtain and coordinate required patient referrals and insurance authorizations to support timely access to services Document eligibility and benefit information on insurance verification form Scan authorization and verification of patient’s eligibility and benefits Communicate with patients regarding their out-of-pocket expenses for large deductibles, limited benefit plans and out-of-network benefits Facilitate payment arrangements when necessary Communicate with appropriate staff members regarding problems relating to patient’s eligibility and benefits Document all necessary patient information and notes in computer system

Core Competences

Responsible for promoting the Standards of Excellence for Orthopedic Specialists while demonstrating courteous and cooperative behavior toward patients, visitors, volunteers, peers and physicians Maintain a neat and orderly work environment, demonstrates the ability to organize and prioritize work during heavy workload situations to expedite patient care Maintain strictest confidentiality in accordance with HIPAA compliance Perform quality work within deadlines with or without direct supervision Work effectively as a team contributor on all assignments Work independently while understanding the need to communicate and coordinate work efforts with other employees and organizations

Minimum Requirements (education, experience, special skills and licenses or certifications required) continued

High School diploma or GED required Associates degree preferred. Minimum of 2 years insurance and benefit experience Ability to perform essential duties Knowledge of medical insurance and billing Ability to document accounts clearly Computer Literate – Windows environment Knowledge of medical terminology Strong organizational skills Ability to perform basic mathematics Ability to clearly communicate written and verbal instructions Ability to efficiently manage multiple tasks and prioritize Ability to demonstrate proper telephone etiquette and computer skills

Essential Physical Functions

Sitting long periods of time Manual dexterity sufficient to operate keyboard, calculator and other office equipment as necessary Ability to view computer screens for long periods of time

Equipment Used

Computer, scanner, printer, calculator, photocopier, facsimile, telephones

Additional Comments

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. They are not intended to be an exhaustive list of responsibilities, duties and skills required of persons so assigned.