Benefits Ver Specialist

Tennessee Orthopaedic Alliance; Clarksville (TN); On-site; USD 36,000 - 45,000; Full time

Job summary

Tennessee Orthopaedic Alliance is seeking an Insurance Verification Specialist to ensure accurate benefit verification for patients across our Middle Tennessee locations. You will work with providers and staff to confirm coverage, referrals, and authorizations, maintaining precise records and effective communication with patients and insurers.

The role supports TOA’s mission to deliver high-quality orthopaedic care while following established procedures and employment policies, including

Qualifications

• High school diploma required.
• 2-4 years of experience in insurance verification preferred.
• Experience reading and understanding payer eligibility electronic returns.
• Ability to differentiate between plans, copay, deductible and coinsurance.
• Requires accuracy, attention to detail, following directions and organization.
• TOA is an equal opportunity employer with drug screens and background checks.

Responsibilities

• Uses the Workflow Daily Appointment Report as a primary source for insurance verification.
• Adheres to best practices in day-to-day follow-up per VOI Manual.
• Calls patients and families, insurers and facility staff to verify information.
• Resolves coverage, referrals and precertification issues; escalates complex items to manager.
• Enters and verifies insurance data, updating records as needed.

Skills

Insurance verification

Payer eligibility

Attention to detail

Documentation

Communication

Education

High school diploma

Job description

Tennessee Orthopaedic Alliance is the largest orthopaedic surgery group in Nashville and Middle Tennessee. TOA concentrates on the diagnosis and treatment of disorders and injuries of the musculoskeletal system which allow our patients to live their best life. Ninety plus years later we are advancing the practice of orthopaedic surgery throughout the state.

There are a number of reasons why TOA is an employer of choice; here are a few of them:

• Stability- TOA has been in Middle Tennessee since 1926 and has expanded to over 20 locations!
• Impact- TOA’s team members use our careers - whether in our clinics or our business office - to make a positive difference in the community by building relationships and helping patients live their best life.
• Work Environment- The TOA team focuses on fostering an excellent working environment; one of positivity, collaboration, job satisfaction, and engagement.
• Total Rewards- TOA offers competitive salaries based on the current Middle Tennessee wage market, plus a comprehensive suite of benefits, including Medical, Dental, Paid Time Off, and more. Our 401(k) plan provides a company match, safe harbor match and profit sharing match to go along with your contributions.

The Insurance Verification Specialist is responsible for the timely verification of medical insurance benefits. Day-to-day activities may include all or some of the essential functions listed below depending upon individual experience / knowledge and the needs of the organization which are subject to change from time to time.

• Utilizes the Workflow Daily Appointment Report for your site as a primary source for insurance verification and determining insurance compatibility with TOA’s managed care plans.
• Adhere to best practices standards in performing day-to-day follow-up tasks.This includes following procedures outlined in the “VOI Training/Procedure Manual”.
• Place phone calls to patients, patient’s family/significant other, insurance companies, and facility personnel in an attempt to acquire information necessary to verify.
• Responsible to resolves any issues with coverage, referrals, precertification and escape complicated issues to the immediate manager.Also must have a basic knowledge and understanding of what a referral and an authorization are.
• Enters and ensures information in the insurance fields is correct to its entirety. If incorrect, information in the system must be updated appropriately. This includes moving any VOB’S, authorizations and clinical referrals. If encounters were billed incorrectly to a now corrected insurance, you must email collections so claims can be rebilled if needed.
• Familiar with a variety of the facility concepts, practices, and procedures. Relies on experience and judgment to plan and accomplish goals.

Job Requirements

• High school diploma required
• 2-4 years of experience in insurance verification preferred
• Must have experience reading and understanding payer eligibility electronic returns, and the ability to differentiate between insurance plans, copay, deductible, and coinsurance
• Requires accuracy, attention to detail, ability to follow directions, and organization skills
• TOA is an equal opportunity employer. TOA conducts drug screens and background checks on applicants who accept employment offers

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.