Clinical Authorizations Representative - St. Petersburg

Responsibilities

• Communicates with patients over the phone in a professional and customer service oriented manner.
• Communicates effectively with staff, secretaries, and physicians by phone, in person or in writing.
• Captures the diagnostic study record for assigned clinic and becomes the record owner.
• Verifies benefit coverage, eligibility for diagnostic study owned in File maker prior to testing date.
• Ensures assigned diagnostic study records are completed in a timely manner.
• Determines whether the patient’s insurance company required pre-authorization and obtains all authorizations, if applicable.
• Able to identify the difference when a prior authorization or a referral is needed prior to the diagnostic studies being performed.
• Identifies, reviews, extracts, and provides clinical notes, durations and response to conservative treatment measures from patient’s visits to the insurance carrier in an effort to obtain a secure pre-authorization for the diagnostic studies.
• Ensures the nature and outcome of the contact with the insurance carrier of each diagnostic test request is documented in File maker, Athena to support claims billing and reimbursement of the diagnostic studies.
• Establishes a good working relationship with Primary Care Physicians’ offices, Insurance and various diagnostic testing facilities and hospitals.
• Maintains a thorough understanding of all major insurance carrier benefit verification and authorization processes. Keeps current with updates for various health plans.
• Maintains and utilizes online access to major insurance carriers.
• Seeks clarification of physician’s diagnostic study orders, if necessary.
• Communicates with the patient on the process of their authorization.
• All other duties as assigned.

• Communicates with patients over the phone in a professional and customer service oriented manner.
• Communicates effectively with staff, secretaries, and physicians by phone, in person or in writing.
• Captures the diagnostic study record for assigned clinic and becomes the record owner.
• Verifies benefit coverage, eligibility for diagnostic study owned in File maker prior to testing date.
• Ensures assigned diagnostic study records are completed in a timely manner.
• Determines whether the patient’s insurance company required pre-authorization and obtains all authorizations, if applicable.
• Able to identify the difference when a prior authorization or a referral is needed prior to the diagnostic studies being performed.
• Identifies, reviews, extracts, and provides clinical notes, durations and response to conservative treatment measures from patient’s visits to the insurance carrier in an effort to obtain a secure pre-authorization for the diagnostic studies.
• Ensures the nature and outcome of the contact with the insurance carrier of each diagnostic test request is documented in File maker, Athena to support claims billing and reimbursement of the diagnostic studies.
• Establishes a good working relationship with Primary Care Physicians’ offices, Insurance and various diagnostic testing facilities and hospitals.
• Maintains a thorough understanding of all major insurance carrier benefit verification and authorization processes. Keeps current with updates for various health plans.
• Maintains and utilizes online access to major insurance carriers.
• Seeks clarification of physician’s diagnostic study orders, if necessary.
• Communicates with the patient on the process of their authorization.
• All other duties as assigned.

• High School Diploma or GED is required.
• Previous customer service experience required.
• 1-2 years experience in a medical environment with experience in medical insurance verification and pre-authorizations.
• Must be proficient in Microsoft Office applications, including Outlook, Excel, and Word.
• Effective written and oral communication, critical thinking and problem solving skills required.
• Knowledge of medical terminology and diagnostic studies.

Orthopaedic Solutions Management is a Drug Free Workplace

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.