Since 1969, OCR has been local and physician-owned with strong ties to the community. With talented, hardworking, and friendly staff, we work toward the common goal of serving residents of CO, WY, and NE with specialty-focused care. We are experiencing tremendous growth and are adding talented people in all of our locations!
The Insurance Coordinator primarily manages all aspects of assigned insurance carriers, including data entry for practice/surgery charges, delivering receipts for patients with insurance, and researching rejected claims to determine an internal procedure for correcting, refiling and follow-up. This position is also responsible for communicating changes in insurances policies, maintaining up-to-date reference materials and ensuring compliance with all insurance rules and regulations. The Insurance Coordinator must have the ability to meet with patients regarding insurance benefits and eligibility as well as implementing external training programs for patients. They maintain accounts receivable aging and routinely audit claims while performing aggressive collection work where necessary.
To perform this job successfully, an individual must have the knowledge, skills, and abilities identified below and be able to perform each essential duty and responsibility satisfactorily, either with or without a reasonable accommodation. The below is intended to describe the general content of and requirements for the performance of this job and is not to be construed as an exhaustive statement of essential functions, responsibilities or requirements.
Essential Duties and Responsibilities
- Maintains up-to-date reference materials on respective insurance rules and regulations and obtains a concise understanding of these regulations for assigned insurance carriers to ensure complete compliance with all insurance rules and regulations for assigned insurance carriers.
- Communicates changes in respective insurance policies to supervisor for dissemination to other staff.
- Responsible for maintaining positive accounts receivable for assigned insurance carriers. Demonstrates consistent and complete resolution collection work on primary and secondary claims.
- Identifies accounts for outside collection on a timely basis and prepares appropriate paperwork for physician-decision and submission to a collection agency, if applicable.
- Obtains a general understanding of insurance carriers assigned to other insurance coordinators and communicates changes and/or adjustments needed.
- Follows up on denials, claim suspensions, and severe reductions in reimbursement promptly, exercise all options to obtain payment.
- Responds to insurance carrier requests for information in a prompt and professional manner.
- Meets with patients regarding insurance benefits and eligibility prior to surgery as well as outstanding patient balances.
- Establishes payment arrangements for patients per guidelines established by the supervisor and follow department protocol for approving arrangements outside of established guidelines.
- Maintains productive, proactive, and positive working relationships with collection agencies.
- Prepares adjustments, as needed, to accounts for assigned insurance carriers and submits to the supervisor for approval, for processing weekly.
- Accepts primary responsibility for answering the business phone outside line.
- Routinely audits coding and demographical data on visit tickets to ensure accuracy of claims.
- Enters charges for practice, surgery and receipts as required.
- Insurance Coordinator Last Updated: 06/2021 Page 2 of 3
- Provides prompt support for check-in personnel regarding insurance eligibility issues (e.g. proper determination of type of account, correct billing information, insurance coverage) at the time the patient is present in the clinic. This may include answering questions over the phone, meeting with patients, or following up with insurance carriers.
- Performs cashiering duties involving settlements of patient accounts and related clerical activities, issuing receipts, preparing bank deposits and maintaining a balanced cash drawer.
- Communicates all concerns, risk management issues, breakdown in protocol and constructive criticisms to supervisor. Follows chain-of-command established by supervisor when addressing protocol issues outside of business office department.
- Maintains a clean and orderly work area including personal area, computer room and record storage area.
- Required to follow OCR as well as departmental policies and procedures.
- Other duties as assigned.
Education and Experience
- High school diploma or equivalent is required.
- Minimum one year experience in the insurance or medical industry or equivalent experience with collections in a business/accounting department.
- Knowledge of medical terminology preferred.
Certificates, Licenses, Registrations
- Quality - Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality.
- Detail Oriented – Consistently checks and rechecks work product for accuracy. Able to manage multiple tasks while accurately performing essential job functions. Prepares accurate and thorough reports, emails, and data as required by the position.
- Oral and Written Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; writes clearly and informatively; Edits work for spelling and grammar; Able to read and interpret written information. Ability to communicate with clients or customers.
- Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.
- Confidentiality - Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy. Adheres to HIPAA guidelines.
Independence of Action
- Work is closely monitored by supervisor/manager; detailed instructions and procedures are generally provided.
- This job has no supervisory responsibilities.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. (The phrases “occasionally”, “regularly”, and “frequently” correspond to the following definitions: “occasionally” means up to one-third of working time, “regularly” means between half and two-thirds of working time, and “frequently” means two-thirds and more of working time.)
- The work environment is the typical office environment. The employee must be able to complete their work satisfactorily in an environment where there are significant distractions, including staff, patients, and vendors walking through and conversing, telephones ringing, conversations carrying over, loud noises, and interruptions to answer questions from others.
- While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel objects, tools, or controls for up to 8 hours per day. The employee frequently is required to talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms, and stoop, kneel, crouch, or crawl.
- The employee will occasionally lift and/or move up to 25 pounds and should do so in a sound and safe manner. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Pay: $18.00 - $25.00/hour, commensurate with experience
- Medical, Dental, Vision coverage
- Life and AD&D Insurance
- Short Term and Long Term Disability Insurance
- Retirement savings and profit sharing plan participation
- Employee Assistance Program
- Continuing Medical Education (depending on position)
- Paid Time Off
*Benefit eligibility is dependent on employment status, and a waiting period may apply.
Orthopaedic & Spine Center of the Rockies (OCR) is an Equal Opportunity Employer and prohibits discrimination or harassment of any kind. OCR is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions are based on business needs, job requirements and individual experience and qualifications, without regard to a person’s race, color, age, sex, gender identity, gender expression, marital status, sexual orientation, religion, creed, national origin, the presence of any physical or mental disability, or status as a disabled veteran, recently separated veteran, other protected veteran, or Armed Forces service medal veteran, or any other protected status.