Description

Are you passionate about serving patients in an inspiring work environment alongside talented people? Get moving with OCR! With over 50 years in business, we are the premier provider of orthopedic care in Colorado, Wyoming, and Nebraska. Our organization continues to grow and we are looking for individuals who share our mission.

The Authorization/Benefits Coordinator primarily manages all aspects of the surgical benefits process including verifying patient benefits, contacting patients regarding eligibility and payment, entering surgical charges and receipts, following up on aging receivables, and resolving any issues related to this process. This position works closely with insurance coordinators to develop knowledge, communicate changes or adjustments and resolve issues with patient accounts.

Essential Duties and Responsibilities

• Determines patient out-of-pocket expenses using estimate provided by surgery authorization personnel and patient insurance plan. Notifies patients of determined expenses and establishes payment arrangements per guidelines and department protocols.
• Provides prompt support for check-in personnel regarding insurance eligibility issues (e.g. proper determination of type of account, correct billing information, insurance coverage) at the time the patient is present in the clinic. This may include answering questions over the phone, meeting with patients, or following up with insurance carriers.
• Maintains complete, accurate and up-to-date notes in patient account regarding surgical benefits and pre-authorizations and disseminates surgery authorization log appropriately.
• Responds to insurance companies’ requests for information in a prompt and professional manner.
• Corrects errors in assigned accounts and communicates other account errors to the respective Insurance Coordinator. Brings all errors to complete resolution.
• Identifies problem accounts on a timely basis and communicates them to supervisor for further action.
• Follows up on all denials, claim suspensions, and severe reductions in reimbursement promptly, exercising all options to obtain payment.
• Demonstrates consistent collection work by monitoring patient accounts for payment of surgical agreements. Follows up with patient and/or Insurance Coordinator regarding outstanding balance of payment issues.
• Routinely audits coding and demographical data on visit tickets to ensure the accuracy of claims.
• Acts as backup for surgery authorization personnel on an as needed basis.
• Communicates all concerns, risk management issues, breakdown in protocol and constructive criticisms to supervisor. Follow chain-of-command established by supervisor when addressing protocol issues outside of business office department.
• Other duties as assigned.

Requirements

• High school diploma or equivalent is required.
• Minimum 1 year experience in the insurance or medical industry or equivalent experience with collections in a business/accounting department.
• Knowledge of medical terminology preferred.

Physical Requirements

• The work environment is the typical office environment. The employee must be able to complete their work satisfactorily in an environment where there are distractions, including staff, patients, and vendors walking through and conversing, telephones ringing, conversations carrying over, and interruptions to answer questions from others.
• While performing the duties of this job, the employee is frequently required to sit and use hands to finger, handle, or feel objects, tools, or controls up to 8 hours per day. The employee frequently is required to talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms, and stoop, kneel, crouch, or crawl.
• The employee may occasionally lift and/or move up to 25 pounds and should do so in a sound and safe manner. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Benefits

• Medical, Dental, & Vision coverage
• Life and AD&D Insurance
• Short- and Long-term disability coverage
• Retirement savings and profit-sharing plan participation
• Employee Assistance Program
• Paid Holidays & Paid Time Off
• Company-sponsored events
• Annual merit increases

*Benefit eligibility is dependent on employment status, and a waiting period may apply.

Orthopaedic & Spine Center of the Rockies (OCR) is an Equal Opportunity Employer and prohibits discrimination or harassment of any kind. OCR is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions are based on business needs, job requirements and individual experience and qualifications, without regard to a person's race, color, age, sex, gender identity, gender expression, marital status, sexual orientation, religion, creed, national origin, the presence of any physical or mental disability, or status as a disabled veteran, recently separated veteran, other protected veteran, or Armed Forces service medal veteran, or any other protected status.