Authorizations Team Lead
Description:
Since 1969, OCR has been local and physician-owned with strong ties to the community. With talented, hardworking, and friendly staff, we work toward the common goal of serving residents of CO, WY, and NE with specialty-focused care. We are experiencing tremendous growth and are adding talented people in all of our locations!
The Team Lead Authorization/Benefits Coordinator acts as a subject matter expert and 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.
Duties Include:
- The Team Lead is a subject matter expert for his/her team. He/she provides process training for new and existing team members, oversees and ensures coverage for lunches/breaks/absences, and communicates and makes recommendations to their Manager/Director on workflow, equipment issues, patient requests or concerns, etc.
- Works closely with insurance coordinators and team leads to develop a thorough understanding of insurance benefit plans to determine patient eligibility.
- Contacts insurance carriers regarding the eligibility of patient benefits for scheduled surgical procedures for OCR physicians performed in various hospitals and/or ambulatory surgery centers ensuring verification and any benefit issues are completed prior to surgery.
- 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.
- Prepares adjustments, as needed, to accounts for assigned insurance companies and submits to insurance coordinators for processing weekly.
- 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.
- Assists insurance coordinators in maintaining aging accounts receivable.
- Maintains working relationships with collection agencies.
- Enters charges for practice, surgery and receipts as required.
- 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.
- Accepts primary responsibility for answering the business phone outside line.
- Performs cashiering duties involving settlements of patient accounts and related clerical activities, issuing receipts, preparing bank deposits and maintaining a balanced cash drawer.
- 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.
- Maintains a clean and orderly work area including personal area, computer room and record storage area.
- Required to follow OCR and departmental policies and procedures.
- Other duties as assigned.
Qualifications Include:
- High school diploma or equivalent is required.
- Minimum one year experience as Authorization/Benefits Coordinator
- Knowledge of medical terminology required.
- Demonstrate ability to communicate and coordinate with insurance companies
- Ability to understand insurance contracts and how to apply surgery procedures
- Excellent organizational and communication skills under minimal supervision
- Strong verbal and written communication skills
- Detail oriented with demonstrated accuracy and thoroughness
Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The phrases “occasionally”, “regularly”, and “frequently” correspond to the following definitions: “occasionally” means up to ⅓ of working time, “regularly” means between ⅓ and ⅔ of working time, and “frequently” means ⅔ and more of working time.
- 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.
Job Type: Full-Time
Location: Loveland, travel to other locations may be required for coverage and staffing needs.
Pay: $20.00 – $27.00 /hour, commensurate with experience
Benefits:
- Medical, Dental, Vision coverage
- Life and AD&D Insurance
- Short Term and Long Term Disability Insurance
- Retirement savings and profit sharing plan participation
- Employee Assistance Program
- Continuing Medical Education (depending on position)
- Paid Time Off
*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.
Posting Information
Posting Date:
May 2, 2022
Location:
Loveland
Department:
Business Office
Job Information
Shift:
M-F
Pay Rate:
$20.00 - $27.00 /hour, commensurate with experience
