Referral and Authorization Coordinator, DME

Established in 2001, Southeast Orthopedic Specialists is a regional leader in orthopedic medicine. We are dedicated to growing with our patients. Our reach will continue to expand to meet the needs of all patients, present and future. It is our wish to make industry-leading five-star orthopedic care accessible to as many people as possible.

At Southeast Orthopedic Specialists, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

As Southeast Orthopedic Specialists continues to grow, we are hiring DME Referral and Authorization Coordinatorfor our Southside Clinic! 

Please see below for the functions and requirements for this position:

GENERAL STATEMENT OF DUTIES

The Referral and Authorization Coordinator for DME is responsible for completing the pre-registration, registration, eligibility verification, verification of benefits and pre-certification/documentation processes which involves communicating with patients, primary care physician offices and insurance companies to ensure that all appropriate demographic and reimbursement information is accurate to prior to the patient’s scheduled appointment.

• High school diploma/GED or equivalent working knowledge preferred.
• Minimum two to three years of experience in a healthcare environment in a referral, front desk or billing role.
• Must be able to communicate effectively with physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers.
• Must have Healthcare experience with Managed Care Insurances, requesting Referrals, Authorizations’ for Insurances and verifying Insurance benefits.
• In-depth knowledge on insurance plan requirements for Medicaid and commercial plans.

ESSENTIAL FUNCTIONS

• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to 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 smooth check-in process for the patient and clinic.
• Fax referral form to providers that do not require any records to be sent.
• Be able to process 75-80 referrals on a daily basis. For primary specialty office visits, fax referral/authorization form to PCPs and insurance companies in a timely fashion.
• Respond to In-house provider and support staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.

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.
• Must be able to communicate effectively with physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers.
• Working knowledge of Centricity Practice Management and Centricity EMR a plus.

REQUIREMENTS

• Must have Healthcare experience with Managed Care Insurances, requesting Referrals, Authorizations’ for Insurances and
  verifying Insurance benefits.
• In-depth knowledge on insurance plan requirements for Medicaid and commercial plans.

KNOWLEDGE

• Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial
  payers and other funding sources.
• Knowledge of government provisions and billing guidelines including Coordination of Benefits.
• Advanced computer knowledge, including Window based programs.

SKILLS

• Skilled in defusing difficult situations and able to be consistently pleasant and helpful.
• Skill in using computer programs and applications.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multi task in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to type a minimum of 45 wpm.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching required.
• Manual dexterity using a calculator and computer keyboard.

** This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills,
abilities and working conditions may change as needs evolve. **

QUESTIONS?

CONTACT - HR@SE-ORTHO.COM

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