Prior Authorization Specialist - Financial Counselor

OrthoLoneStar; Austin (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

OrthoLoneStar is seeking a Prior Authorization Specialist - Financial Counselor responsible for insurance verifications and patient consultations. This entry-level role requires attention to detail and effective communication, offering a competitive hourly pay based on experience. Ideal candidates will possess prior experience in a medical setting and be proficient in medical terminology.

Qualifications

• Two years of previous experience in a medical office setting.
• Experience with insurance benefit verification.

Responsibilities

• Responsible for all insurance verifications and benefit documentation.
• Prepare estimates for procedures and collect payments from patients.
• Consult with providers to confirm medical necessity before procedures.

Skills

Knowledge of medical and insurance terminology

Attention to detail

Effective communication

Ability to work in a fast paced environment

Education

High School diploma

Job description

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This range is provided by OrthoLoneStar. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$15.00/hr - $24.00/hr

**MUST RESIDE IN TEXAS, REMOTE POSITION AFTER ONBOARDING AND APPROVAL TO GO REMOTE**

GENERAL JOB DESCRIPTION : Responsible for all insurance verifications, benefit documentation, referrals, preparing procedure estimates and authorization for assigned location(s)/doctor(s).

Essential Functions

• Correct and update Registration Information to ensure accuracy in claims filing as identified in the patient account
• Prepare estimates for all procedures, notify patients and collect prior to procedures for assigned doctor(s)
• Consults with the appropriate provider to obtain clearance that treatment regimen is considered medically necessary before initiating request to the insurance plan.
• Verifies eligibility and notifies appropriate parties if eligibility has termed.
• Processes referrals as needed, based upon insurance plan.
• Submits medical records, works with the provider on necessary documentation, if necessary, to obtain authorization.
• Notifies clinical staff, related physician and supervisor of any delays in obtaining authorization.
• Schedules Peer-to-Peer calls when necessary.
• Communicates any issues with authorization to team lead and appropriate surgery coordinator.
• Handle patient calls for assigned doctor(s) as necessary, responding within 24 hours.
• Issue appropriate paperwork for accounts requiring adjustments, patient refunds and corrections when identified.
• Obtain necessary referrals, document in Referral Management and attach referral in schedule/visit
• Receives questions from Office Manager for time of service collection issues the manager cannot resolve with the patient
• Work with RCM and Reception Manager to identify ways to increase efficiency in demographic entry
• Other duties as assigned.
  
  

Qualifications

Education : High School diploma

Experience

• Two year previous experience in a medical office setting
• Previous experience with insurance benefit verification
  
  

Licensure

Special Skills :

• Knowledge of medical and insurance terminology
• Attention to detail
• Ability to effectively communicate both orally and written
• Ability to work in a fast paced environment
  
  

Physical Demands

• Must have adequate visual acuity to read, the ability to interpret and understand written material.
  
  

Environmental Working Conditions

• Continuously handle multiple tasks simultaneously and work as a part of a team.
• No conditions of chemicals/fumes/odors and dust/messiness.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Medical Practices

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