Healthcare Benefits Specialist

2 weeks ago

Tustin, California, United States VQ Orthocare Full time
Job Overview

Summary: The Healthcare Benefits Specialist is essential in confirming patient benefits, negotiating terms, and securing pre-authorizations from a variety of payors, including group health, Medicare, managed care, workers' compensation, personal injury, and government programs. This role requires managing complex projects that necessitate specialized expertise to address challenges and complete tasks effectively.

Key Responsibilities:

  • Timely processing of new orders: Orders received by noon PT must be finalized on the same day (Monday-Friday, excluding holidays).
  • Thorough review and validation of documentation: Ensure all medical records and prescriptions meet company standards and payor requirements.
  • Confirm insurance coverage and secure prior authorizations as necessary.
  • Communicate with adjustors to verify active claims, accepted body parts, vendors, and required documentation.
  • Establish and nurture positive relationships with patients, manage their expectations, and communicate effectively.
  • Initiate patient outreach within 24 hours of receiving orders to discuss authorization, benefits, and payment options.
  • Provide comprehensive product information, pricing details, explain payment alternatives, and discuss insurance coverage for reimbursement.
  • Assist patients in arranging payment plans, managing co-payments, deductibles, and specialized payment arrangements.
  • Stay informed about industry developments, implement process improvements, and contribute to departmental and organizational goals.
  • Exhibit ethical conduct, professionalism, adhere to company policies, and handle stressful situations with diplomacy.

Competencies:

  • Job Specific Duties: Effectively support the Sales Department's initiatives.
  • Industry Knowledge & Business Acumen: Maintain a solid understanding of company policies, industry trends, product knowledge, and effectively resolve complex projects.
  • Communication and Ethics: Represent the organization ethically, making decisions that align with the company's best interests.

Education and Experience:

  • High School Diploma/GED is required.
  • Associate's Degree is preferred.
  • At least 2 years of relevant experience or a combination of education, training, and experience is required.

Qualifications:

  • Minimum of 2 years of experience in processing orders within a healthcare environment.
  • 2+ years of experience in insurance verification.
  • Proficient in interpreting insurance Explanations of Benefits (EOBs).
  • Advanced skills in Microsoft Word, Excel, PowerPoint, and other Office applications.
  • Strong aptitude for mathematical calculations.

Preferred Qualifications:

  • Fluency in Spanish is advantageous.

Physical and Mental Demands:

  • Interacts with staff, peers, senior management, and external clients.
  • Ability to manage moderate to high levels of stress.
  • Tasks may involve sitting, standing, moving, bending, reaching, and lifting items up to 20 pounds.
  • Requires reading and analyzing computer data, reports, and utilizing various electronic devices.
  • Regular data entry and typing tasks using computer keyboards.

Certificates and Licenses:

  • No specific certificates, licenses, or registrations are required.

Supervisory Responsibilities:

This position does not entail supervisory duties.

Work Environment:

Reasonable accommodations may be provided for qualified individuals with disabilities to perform essential functions. The work environment varies from an office setting to patient home environments, with typical noise levels being low to moderate.

Company Overview: VQ Orthocare is a DME manufacturer and retailer that has proudly served the industry for over 25 years.

  • Healthcare Billing Specialist

    2 weeks ago

    Tustin, California, United States Allstarmedicalsupply Full time

    Company: AllstarmedicalsupplyJob Title: Healthcare Billing SpecialistSalary: $25-$30 per hourLocation: On-SitePosition Overview:The Healthcare Billing Specialist plays a crucial role in managing the billing and accounts receivable processes for medical claims. This position demands a comprehensive understanding of billing guidelines, coding practices, and...

  • Healthcare Billing Specialist

    2 weeks ago

    Tustin, California, United States Families Together of Orange County Full time

    Job OverviewSalary: $25-30/hrCompany: Families Together of Orange CountyPosition: Medical Biller - Authorization SpecialistLocation: On-SiteAvailable Positions: 1Position Summary:The Authorization Specialist plays a crucial role in the healthcare billing department by managing the process of obtaining prior authorizations for medical services, treatments,...

  • Hearing Healthcare Specialist

    1 week ago

    Tustin, California, United States Tustin Fyzical Fall Prevention Center and ENT Sinus & Allergy Full time

    Position Title: Audiology SpecialistOrganization: Tustin Fyzical Fall Prevention Center and ENT Sinus & AllergyPossession of a Master's or Doctorate Degree in AudiologySAC Certification or eligibility for certificationCalifornia dispensing license or eligibility for licensureKey Responsibilities:Conduct diagnostic assessments including Tympanometry,...

  • Healthcare Revenue Cycle Specialist

    1 week ago

    Tustin, California, United States SG HOMECARE INC Full time

    Job OverviewThe Healthcare Revenue Cycle Specialist will collaborate closely with both internal and external teams, including insurance providers, serving as a subject matter expert (SME) to pinpoint and rectify systemic payment challenges within the Revenue Cycle Management (RCM) department. This role encompasses RCM process evaluation and enhancements,...

  • Travel Nurse ICU Specialist

    20 hours ago

    Tustin, California, United States Aequor Healthcare Full time

    Aequor Healthcare is seeking a skilled travel nurse ICU specialist to fill a travel nursing position in a dynamic and fast-paced ICU environment.**Job Summary:**We are looking for a highly motivated and experienced ICU travel nurse RN to join our team. As a travel nurse ICU specialist, you will be responsible for providing high-quality patient care in a...

  • Travel Nurse RN

    3 days ago

    Tustin, California, United States Aequor Healthcare Full time

    Job OverviewAequor Healthcare is seeking a skilled travel nurse RN ICU specialist to join our team.Job Summary:Specialty: Intensive Care UnitDiscipline: RNTravel Nursing opportunityResponsibilities:Provide high-quality patient care in the ICU settingCollaborate with interdisciplinary teams to develop and implement patient care plansContribute to a positive...

  • Healthcare Support Specialist

    2 weeks ago

    Tustin, California, United States Families Together of Orange County Full time

    Job OverviewSalary Range: $21 - $27 per hourCompany: Families Together of Orange CountyPosition Summary: We are seeking dedicated Medical Assistants to provide essential support in various healthcare settings. The role is crucial in assisting healthcare providers with patient care and performing necessary medical assistant responsibilities.Available...

  • Healthcare Office Support Specialist

    6 days ago

    Tustin, California, United States LHH Recruitment Solutions Full time

    Job SummaryLHH Recruitment Solutions is seeking a highly skilled and bilingual Medical Office Admin to join our team in a dynamic and fast-paced environment.Provide exceptional customer service to patients and visitors, ensuring a positive and welcoming experience.Manage incoming calls, screening and routing as needed, and maintain accurate phone notes in...

  • Travel Nurse RN Telemetry Specialist

    2 days ago

    Tustin, California, United States Aequor Healthcare Services Full time

    Aequor Healthcare Services is seeking a skilled Travel Nurse RN Telemetry Specialist for a challenging travel nursing opportunity.**Job Summary:**We are looking for a highly motivated and experienced Registered Nurse Telemetry Traveler to join our team. The ideal candidate will have a proven track record of providing exceptional patient care in a telemetry...

  • Healthcare Risk Management Specialist

    1 week ago

    Tustin, California, United States Alta Hospitals Full time

    Clinical Risk ManagerThe Clinical Risk Manager plays a pivotal role in overseeing clinical risk management initiatives, ensuring patient safety, addressing patient grievances, and conducting data analysis at Alta Hospitals. This fully accredited healthcare facility is equipped to provide comprehensive care.Lead the development and execution of clinical risk...

  • Veterinary Technician

    3 days ago

    Tustin, California, United States Thrive Pet Healthcare Full time

    About the RoleWe are seeking a highly skilled and compassionate Registered Veterinary Technician to join our team at Thrive Pet Healthcare. As a Veterinary Technician - Ophthalmology Specialist, you will play a vital role in providing exceptional care to our patients and their families.Key ResponsibilitiesSupport veterinarians in ensuring quality veterinary...

  • Urogynecology Specialist

    1 week ago

    Tustin, California, United States Provider Solutions & Development Full time

    Join Our Team as a Urogynecology SpecialistProvider Solutions & Development is excited to announce an opportunity for a Urogynecology Specialist to become a vital part of our dedicated team. This full-time position is designed for those who thrive in a collaborative and supportive environment, focusing on women's health and well-being.Position...

  • Behavior Support Specialists

    2 weeks ago

    Tustin, California, United States Amergis Full time

    Amergis Healthcare Staffing is seeking dedicated full-time Behavior Support Specialists to assist students in K-12 educational settings.The role of a Behavior Support Specialist involves providing assistance to students who need behavioral intervention by employing Applied Behavior Analysis (ABA) techniques to address challenging behaviors and ensuring that...

  • Healthcare Support Specialist

    2 weeks ago

    Tustin, California, United States Families Together of Orange County Full time

    Position OverviewSalary Range: $21 - $27 per hourOrganization: Families Together of Orange CountyRole Summary: We are seeking dedicated Medical Assistants to provide essential support in patient care across various locations.Job Title: Medical Assistant (Back Office)Compensation: $21 - $27 per hourLocation: Garden Grove (On-Site)Available Positions: 1The...

  • Quality Assurance Manager in Healthcare

    1 week ago

    Tustin, California, United States Families Together of Orange County Full time

    Job OverviewPosition Title: Healthcare Quality ManagerCompensation: $35 Per HourLocation: TreehavenAvailable Positions: 1Position Objective: The Healthcare Quality Manager will be accountable for the administration of the quality management framework at Families Together Community Health Center (FTOC). This role is essential in ensuring that the clinic...

  • Travel Nurse ICU Specialist

    3 days ago

    Tustin, California, United States Epic Travel Staffing Full time

    Job Title: Travel Nurse ICU SpecialistJob Type: Travel NursingLocation: Tustin, CaliforniaJob Description:Job SummaryEpic Travel Staffing is seeking a highly skilled and experienced Travel Nurse ICU Specialist to join our team. As a Travel Nurse ICU Specialist, you will be responsible for providing high-quality patient care in a fast-paced Intensive Care...

  • Pediatric Specialist

    2 days ago

    Tustin, California, United States FusionWorks Full time

    About the Role:FusionWorks is seeking a highly skilled Pediatric Specialist to join our team. As a Pediatric Specialist, you will be responsible for providing comprehensive care to children and adolescents from birth to 18 years old.Key Responsibilities:Deliver high-quality patient care, including routine check-ups, vaccinations, and treatment of illnesses...

  • Housekeeping Specialist

    2 days ago

    Tustin, California, United States Marriott International Inc Full time

    About the RoleWe are seeking a skilled and detail-oriented Housekeeping Specialist to join our team at Marriott International Inc. As a Guest Environment Expert, you will be responsible for maintaining the appearance and cleanliness of our hotel, ensuring a safe and welcoming environment for our guests.Key ResponsibilitiesMaintain the cleanliness and...

  • Travel Nurse RN Specialist

    3 days ago

    Tustin, California, United States Aequor Healthcare Full time

    Aequor Healthcare is seeking a skilled travel nurse to join their team as a Telemetry RN. This is a 13-week travel nursing job opportunity in a dynamic healthcare setting.Job Requirements:Specialty: TelemetryDiscipline: Registered Nurse (RN)Duration: 13 weeksHours: 36 hours per weekShift: 12 hoursEmployment Type: TravelAbout the Job:Aequor Healthcare is a...

  • Travel Nurse RN Specialist

    3 days ago

    Tustin, California, United States Aequor Healthcare Full time

    Job SummaryAequor Healthcare is seeking a skilled travel nurse RN to fill a Telemetry position in a dynamic healthcare setting.Key ResponsibilitiesProvide high-quality patient care in a Telemetry unitCollaborate with interdisciplinary teams to develop and implement patient care plansMonitor and analyze patient data to inform clinical decisionsCommunicate...