Surgical Operations Coordinator

2 weeks ago

Dedham, Massachusetts, United States Boston Sports & Shoulder Full time
Job Overview

The Surgical Coordinator at Boston Sports & Shoulder is tasked with managing patient pre-authorizations, pre-certifications, and ensuring that medical documentation is accurately maintained.

Key Responsibilities

The primary duties encompass, but are not limited to:

  • Submitting accurate claims to various insurance providers through electronic or paper methods.
  • Addressing inquiries from patients, administrative staff, and insurance representatives.
  • Identifying and resolving billing discrepancies raised by patients.
  • Processing referrals and authorizations according to the protocols established by insurance entities.
  • Acting as a mediator between insurance companies and healthcare practitioners to confirm that necessary referrals are properly executed for specialty consultations.
  • Updating and documenting records to guarantee that all stakeholders have precise information.
  • Engaging with patients to ensure continuity of care regarding referrals and other healthcare needs.
  • Assisting the care team and patients in coordinating care with specialists and diagnostic facilities.
  • Meticulously recording all relevant information in Electronic Health Records (EHR) or Electronic Medical Records (EMR).
  • Serving as a resource for patients concerning workers' compensation, insurance, and referral matters, with the capability to perform electronic insurance verifications.
  • Scheduling appointments, conducting follow-up communications, and documenting visit details; transmitting referral information to medical offices and diagnostic centers.
  • Handling phone communications, taking messages, and responding to routine inquiries from patients, physicians, and clients.
  • Providing assistance and information to patients and providers to resolve and manage complex administrative challenges.
  • Maintaining acceptable productivity levels and ensuring timely claims reimbursement while meeting work queue objectives.
  • Ensuring that records are processed within the department's established service standards.
  • Reviewing accounts for potential assignment and advising the Billing Supervisor; preparing documentation for collection agencies.
  • Assisting in the renewal of provider licenses.
  • Conducting various collection activities, including contacting patients by phone; correcting and resubmitting claims to third-party payers.
  • Processing payments from insurance companies and preparing daily financial deposits.
  • Participating in educational initiatives and attending monthly staff meetings.
  • Upholding the highest standards of confidentiality; adhering to all HIPAA regulations and guidelines.
  • Performing additional job-related tasks as assigned.
Qualifications
  • High school diploma or GED is preferred.
  • Familiarity with medical billing and collection practices.
  • Understanding of business office protocols.
  • Knowledge of basic medical coding and third-party operational procedures.
  • Proficiency in operating computers, software applications, and standard office equipment.
  • Ability to manage a multi-line telephone system.
  • Skilled in providing courteous and helpful telephone assistance.
  • Capability to read, comprehend, and follow both oral and written instructions.
  • Aptitude for establishing and maintaining effective working relationships with patients, colleagues, and the public.
  • Strong organizational skills and attention to detail.
Work Environment

The physical demands outlined here are representative of those that must be met by an employee to successfully execute the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

While fulfilling the responsibilities of this position, the employee is regularly required to communicate effectively. Frequent use of hands or fingers to handle objects, tools, or controls is necessary. Occasional standing, walking, sitting, and reaching with hands and arms may be required. The employee may need to lift and/or move up to 25 pounds. Specific vision abilities required for this role include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is typically low to moderate.

This job description does not imply that these are the only duties to be performed by the employee. Employees may be required to follow any other job-related instructions and perform any other job-related duties as requested by authorized personnel. All duties and responsibilities are essential functions and requirements and are subject to modification to reasonably accommodate individuals with disabilities.

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