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Patient Access Representative II

2 months ago

Gainesville, United States Orthopaedic Solutions Management Full time
Job DescriptionJob Description

Key Responsibilities:

Scheduling/Benefits Rep:

  • Register all new patient in the computer system by obtaining patient demographics and insurance information and source of referral.
  • Schedule appointments according to patient need and physician and authorization protocols.
  • Verify benefits through electronic eligibility system to confirm effective date of insurance coverage, PCP Information, whether referral is required, co-pay or co-insurance information to ensure patient responsibility is collected at time of service.
  • All obtainable benefit information at time of scheduling should be properly documented in the system so that any visits that need further financial clearance can be easily passed off the Financial Clearance Team.
  • Update all information from prior visit if needed.

Authorization Rep:

  • Coordinate with appropriate primary care physicians and/or insurance companies to obtain referrals for office visits prior to the patient’s scheduled appointment.
  • Ensure all authorizations are properly documented in the system.
  • Advise patients of any potential problems concerning obtaining authorization prior to the scheduled appointment.
  • Coordinate with the Billing/Collections department to research and obtain authorizations on previously denied claims.
  • Coordinate with the Benefit Verification Rep to confirm benefits when problems occur.
  • Utilize insurance websites (Availity, Humana Military (Tricare), United Healthcare, etc.) to obtain referrals/authorizations.

Both Positions:

  • Assure compliance with all company plans policies and procedures set forth by the Florida Orthopaedic Institute
  • All other duties as assigned.