Neurotech NA Inc - a wholly-owned subsidiary of Theragen Inc
We are a team of experts dedicated to helping patients recover more successfully from spinal fusion procedures. We are not only the manufacturer of our flagship product, ActaStim-S, but also the national Durable Medical Equipment (DME) supplier, serving patients across the United States.
We are looking for an Insurance Authorization Specialist to join our Jacksonville-based team. This role will be responsible for communicating product benefits to insurance companies, workers compensation providers and Veterans Affairs Medical Centers to obtain authorizations, in-network inclusions and/or purchase orders. The ideal candidate will be able to keep the patient front of mind and evolve processes and policies to better assist patients and the Company in navigating complex authorization processes, whilst maintaining full compliance with local, national and contractual regulations.
This is not a call-center position - you will be working closely with our Order Conversion Specialists, our Reimbursement and Contracting Spcialists, and our Sales Team.
Who We Want
· Teammates: Partners who work as hard as we do, listen to ideas, share candid feedback and work together to move our Company forward
· Continuous Improvers: Experts who understand that achieving perfection requires constant evolution and who are ready to challenge pre-existing operational norms and propose alternative approaches.
· Excellent Communicators: Articulate professionals who are persuasive, detail-oriented and authentic in both verbal (phone) and written communications
· Multitaskers: Hard-working gogetters who are self-driven, able to manage competing priorities and remain calm under pressure.
Duties and Responsibilities:
1) Contact health insurance companies to verify patient benefits and determine prior authorization requirements as well as obtain details of patient deductible, out of pocket max and coinsurance. This may be via phone call or online via portals such as Availity.
2) Identify documentation needed to support requests for prior authorization and work with the order conversion specialists to obtain these if not already on file.
3) Submit requests for Single Case Agreements, GAP inclusions and in-network inclusions for non-contracted health insurance companies.
4) Negotiate with Workers Compensation, Liability insurances and Veterans Affairs Medical Centers to obtain purchase orders. Present the unique benefits of our products, agree pricing and obtain purchase orders.
5) Routine follow up on WIP orders to ensure authorization, agreements or purchase orders are received timely.
6) Support the order conversion specialists in entering orders into the Brightree billing system as needed.
7) Review prior authorization denials and craft appeal packages designed to address denial-specifics.
8) Assist patients in navigating the programs the Company offers to assist with out of pocket expenses, including, but not limited to, establishing payment plans or qualifying patients for Economic Assistance Program and obtaining all required documentation.
9) Work with Customer Experience team to ensure all reps, prescribers, patients and payors receive VIP Customer Care, escalating patient or rep concerns to Customer Experience team as needed.
10) Perform special projects as identified for continuous business improvement.
11) Adhere to all policies and procedures to ensure the Company’s compliance with all local and national regulatory requirements – including but not limited to HIPAA, HQAA/Medicare, FDA and any other regulatory requirements.
Qualifications:
Bachelor or Associate degree in Healthcare, Business, General Studies, Marketing or any other related discipline
And/Or
2-3 years’ experience in a Surgical Scheduler, Authorization Specialist or Medical Billing role.
Job Type: Full-time
Pay: $40,000.00 - $70,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Weekly day range:
Ability to Relocate:
- Jacksonville, FL 32256: Relocate before starting work (Required)
Work Location: In person