Insurance Specialist, Front Desk Associate Hand Therapy Technician

Position Summary: This position divides time between the Insurance Specialist and Front Desk Associate, HT Technician roles. Responsibilities include verifying insurance benefits, obtaining authorization, and/or referrals for the Hand Therapy (OT) department. While in the clinic, this position will be responsible for assisting the hand therapy team to provide timely, friendly, and accurate customer service.


Responsibilities/Accountabilities:

Insurance Specialist

1. Verify insurance eligibility and benefits including co-pays, deductibles, co-insurance and covered and non-covered services, online or by phone.
2. Obtain authorization for evaluation, treatment and DME as required by insurance and document appropriately. Regularly check the status of pending authorizations and update the referral with the authorization number, visit number, and expiration date.
3. Notify providers through "To Do" when same day faxing of documentation is required to ensure timely submission of requests.
4. Upload or fax appropriate documentation to insurance companies.
5. Add patients to the calendar when additional visits are required, and update referrals as needed.
6. Annually re-verify existing patient insurance coverage as required. Update referrals and NOB for new policy period.
7. Other duties as assigned by leadership.

Customer Service/Front Desk Support:

1. Interact with patients to promote a friendly and positive atmosphere.
2. Verify that proper documents, such as prescriptions and prior authorizations, are completed and documented in the patient chart prior to appointments.
3. Verify that notes are correct in the appointment description.
4. Accurately and efficiently complete patient check-in and clarify that the accurate insurance card is scanned into the EMR system.
5. Verify that the current insurance is running "active" in EMR system.
6. Track patient visits as required for authorization approval.
7. Provide new patients with appropriate intake paperwork and proof of delivery documentation.
8. Answers telephone calls and complete a warm transfer of calls as appropriate. Work within the hand therapy department phone group to balance phone volume.
9. Scans appropriate documentation into patient chart.
10. Completes daily cash out and day sheet reports.
11. Fax documentation to outside referral sources.
12. Communicate with therapists, patient care coordinators, and mid-level providers regarding appropriate patient issues such as scheduling, authorization information, etc.

Clinic Support

1. Communicates with the therapists to ensure timely start time and set-up of patient's treatment.
2. Clean and sanitize all equipment/table after each patient treatment.
3. Complete weekly cleaning tasks as outlined in clinic documents provided during orientation.
4. Stock and organize supply inventory. Organize splint materials, hand-outs, and replenish clinic supplies. Communicate with leadership concerning supply needs.
5. Complete laundry duties.
6. Calibrates BTE regularly.
7. Complete temperature checks as required for therapy modalities (i.e. paraffin bath, hydrocollator).

Scheduling:

1. Schedule patients for therapy appointments at the appropriate frequency and duration determined by the therapist. In addition, coordinate follow-up appointments with physicians and mid-level providers as needed.
2. Create a referral and send "To Do" to an insurance specialist with the insurance and ID number in the subject line.
3. Accurately complete all required fields on EMR including appropriate appointment codes.

Business Office/Billing:

1. Explain insurance benefits to patients and assists with obtaining notification of benefits/authorizations as indicated by location needs.
2. Collects co-payments, high-deductible deposits, unpaid balances, and payment of self-pay items.
3. Obrain MY CGS same/similar information for all new patients at the primary location. Scan the document into the medical chart.
4. Verify that superbills and referrals have appropriate referral source and add notes as indicated.
5. Update EMR notes and alerts.
6. Coordinate with the physician's team BWC approval, obtain date extensions, and facilitate documentation for continuation of care for BWC patients.

Teamwork:

1. Works cooperatively with coworkers, providers, and management.
2. Shares knowledge and insights with co-workers in a constructive manner.
3. Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
4. Addresses conflicts with person directly before involving manager or uninvolved peers.
5. Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.

Policies and Procedures:

1. Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
2. Provides assistance and support to leadership in implementing policies and procedures as necessary.
3. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

Education, Experience, and Certification/Licensure Required:
A high school diploma or equivalent is required. Previous experience in a healthcare setting or Occupational Therapy department is preferred. Basic knowledge and adaptability to EMR systems. Basic knowledge of medical terminology and insurance coding is strongly preferred.