Referral and Authorization/Durable Medical Equipment

1 month ago


West Palm Beach, United States Center for Orthopedic and Research Excel Full time
Job DescriptionJob Description

Center for Bone & Joint Surgery of the Palm Beaches is a multi-location medical practice devoted to the diagnosis and treatment of injuries and diseases of the body's musculoskeletal system. Our locations feature a staff of highly trained orthopedic surgeons, each with a specific area of expertise.

Center for Bone & Joint Surgery of the Palm Beaches offers a team approach to your care and provides a variety of services right on campus designed for your convenience and ensuring an outstanding continuum of care. These include on-site X-ray, on-site MRI, on-site physical therapy, and aquatic therapy.

ESSENTIAL FUNCTIONS
• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations (referrals, precertification) after patient arrival for all ambulatory
visits, procedures, injections, and radiology services.
• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance
eligibility.
• Creates appropriate referrals to attach to pending visits.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms
as necessary to allow processing of claims to insurance plans.
• Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.
• Researches all information needed to complete the registration process including obtaining information from providers,
ancillary services staff, and patients.
• Fax referral form to providers that do not require any records to be sent. Be able to process 75-80 referrals daily. For primary
specialty office visits, fax referral/authorization form to PCPs and insurance companies in a timely fashion.
• Reviews and notifies front office staff of outstanding patient balances.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue
goals.
• Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals,
care coordination, or follow-up status.
• Identifies and communicates trends and/or potential issues to the management team.
• Index referrals to patient account for existing patients.
• Create new patient accounts for non-established patients to index referrals.
*The job holder must demonstrate current competencies for this position.

EDUCATION
• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE
• Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role.



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