Insurance Verification / Authorization Specialist

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We are the leaders in the orthopedic community of East Central Florida, The Orthopedic Clinic has served our community since 1961. We get our patients back to the life they love with high quality, individualized orthopedic care. The Orthopedic Clinic is seeking an enthusiastic and driven candidate that has previous experience with verifying insurance eligibility and referrals to join our dedicated team as an Insurance Verification / Authorization Specialist.

The Insurance Verification / Authorization Specialist will be responsible for verifying insurance eligibility and benefits, securing referral and authorizations for services and coordinating with clinics and patients to address payor authorization issues. Our Insurance Verification / Authorization Specialist will be skilled in maintaining effective working relationships with co-workers, third party payors, and patients while maintaining exemplary customer service skills and a passion for quality healthcare.

We believe every patient should receive the best possible care, our practice offers an array of services specializing in general orthopedics, spine care, sports reconstruction, adult reconstruction and non-surgical treatments. We currently have eleven Orthopedic Surgeons, one Interventional Pain Management Physician, Mid-Level Providers, and a Physical Therapy team who serve patients at four locations within Volusia and Flagler counties.

What the Insurance Authorization Coordinator will do:

• Performs insurance verification and obtains initial and subsequent preauthorization for services, including procedures, surgeries, medication, injectable, imaging and DME.
• Submits, processes, tracks, and follows up on all referrals requested by providers in a timely fashion.
• Establishes an effective and highly efficient workflow ensuring insurance-based authorizations are obtained for all diagnostic procedures
• Performs insurance verification and benefit check for all patients prior to scheduling
• Manage Orders submitted to Imaging Facilities and outside Referral Networks and obtain prior authorization as needed.
• Manage Orders submitted to Specialty/Local Pharmacy and obtain prior authorization as needed.
• Communicates with physicians and department staff when there are issues with authorization
• Knowledge of the principles and practices of physician billing, out of network benefits, collection administration, industry and government regulations and reimbursements.
• Contacts insurance companies via phone and/or web to verify client’s medical benefits and provides Insurance with basic clinical information in patients chart to justify medical necessity

Experience and Abilities:

• Minimum of High School Diploma
• Previous referral / authorization experience in medical/healthcare setting
• Proficiency in the use of Microsoft Office Products, EHR software applications, preferably Athena
• Valid Driver’s License / Clean Driving Record/ Proof of auto insurance

The Orthopedic Clinic is an Equal Opportunity Employer and fully subscribe to the principles of Equal Employment Opportunity. Applicants and/or employees are considered for hire, promotion and job status, without regard to race, color, citizenship, religion, national origin, age, sex (including sexual harassment, sexual orientation, and gender identity), disability or handicap, genetic information, citizenship status, veteran, or current or future military status or any other category protected by federal, state, or local law. The Orthopedic Clinic is a drug free workplace all applicants under consideration for employment will be drug screened and background checked as part of the hiring process.