PROCEDURE INSURANCE COORDINATOR

| **JOB TYPE:** | Insurance Coordinator | | --- | --- | | **HOME COMPANY:** | Gulf Coast Spine | | **REPORTS TO:** | Billing Office Manager | | **FLSA STATUS:** | Non-Exempt | | **PRE-REQUISITE:** | none | | **UPDATED/REVIEWED:** | 3/25/2024 | | **SCOPE OF RESPONSIBILITIES** | | | --- | --- | A nonexempt position responsible for Insurance Coordinator. | **ESSENTIAL DUTIES AND RESPONSIBILITIES** include the following. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different functions be performed when circumstances change or exigencies require (this includes but is not limited to emergencies, changes in personnel, workload, rush jobs, or technological developments). | | | --- | --- | 1. Review of payer coverage determinations and submission of surgical procedures authorizations. 2. Interpretation and review of patient insurance benefits as it relates to booked surgeries. 3. Works in collaboration with clinical staff to ensure that all medical necessity criteria are met and documented in the proper locations of the patient chart. 4. Will act as a liaison to the billing department to ensure that any post-surgical payment issues are resolved timely. 5. Works with patients to ensure that any potential financial obstacles are addressed, including determining patient eligibility for financial assistance, payment plans, or Care Credit application. 6. Understands payer policy for all government and commercial insurances. 7. Utilizes online resources to identify updates and changes in policy. 8. Research exceptions and determine the appropriate resolution. 9. Communicate with Billing Department Management, payor organizations and other relevant parties to ensure timely resolution of exception items. 10. Achieve and maintain performance consistent with requirements for productivity, quality, and service levels. 11. Develop and maintain productive team-oriented relationships through individual contacts and group meetings. 12. Communicates with other team members in clinical and clerical areas to provide a successful patient centered practice. 13. Other duties as assigned. **NTIA**s may be assigned. | **EDUCATIONAL REQUIREMENTS** **** | | | --- | --- | 1. High School diploma, GED or equivalent 2. Associate degree preferred, but not required. **** | **EXPERIENCE/OTHER REQUIREMENTS** **** | | | --- | --- | 1. Minimum 5yrs previous experience in healthcare authorizations with government and commercial payer policies and authorizations. 2. Prefer NextGen Practice Management or EPIC system experience. 3. Type minimum of 45 wpm 4. Excellent Excel skills 5. Ability to problem solve as well as critical thinking. 6. Proficient in professional and effective communication skills 7. Demonstrate a strong attention to detail and thoroughness. 8. Effectively utilize available relevant technical tools and resources (e.g. Microsoft, Outlook) | **KNOWLEDGE** **** | | | --- | --- | 1. Knowledge of medical terminology, anatomy, physiology, pharmacology, and pathophysiology. 2. Familiarity with health care system, regulations, policies, and functions. 3. Understanding of documentation standards. 4. Knowledge of equipment. supplies, and material needed for medical treatment. | **SKILLS & ABILITIES** **** | | | --- | --- | 1. Skill in reading and following written and oral medical order. 2. Skill in initiating appropriate emergency procedures. 3. Skill in handling several tasks simultaneously. 4. Skill intact and diplomacy in interpersonal interactions. Abilities: 1. Ability to communicate calmly and clearly with providers and employees. 2. Ability to establish and maintain effective working relationships with coworkers and diverse patient populations. 3. Ability to work with computer and effectively use electronic medical records (EMR). 4. Ability to work under pressure. 5. Ability to type minimum of 35 wpm 6. Excellent Excel skills 7. Ability to problem solve…