With over 50 years in business, OCR is the premier provider of orthopedic care in Colorado, Wyoming, and Nebraska. We are dedicated to providing the highest quality, state-of-the-art, comprehensive orthopedic care through a dynamic network of best-in-class orthopedic specialists based on each patient’s unique, individual needs. Our organization continues to grow and we are looking for individuals who share our mission! 

The Authorization and Benefits Coordinator Team Lead acts as a subject matter expert and primarily oversees all aspects of the authorization process including pre-certifying upcoming Surgeries/MRIs/Injections/Therapy, verifying patient benefits, contacting patients regarding eligibility and payment, and working to resolve any issues related to the process.

Essential Duties and Responsibilities 

• The Team Lead is a subject matter expert for their team. They will provide process training for new and existing team members, oversee and ensure coverage for lunches/breaks/absences, and communicate and make recommendations to their Manager/Director on workflow, equipment issues, patient requests or concerns, etc.
• The Team Lead triages physician orders (i.e., check for insurance, place-of-service, procedure type, diagnosis, etc.) to verify everything looks appropriate.
• Obtains authorizations from insurances by submitting supporting medical documentation and receiving pre-approvals prior to the physician ordered procedures.
• Works closely with the Authorization Data Entry team to develop a thorough understanding of insurance benefits to determine patient eligibility.
• Contacts insurance carriers regarding the eligibility of patient benefits for scheduled procedures while ensuring verification and any benefit issues are handled prior to the ordered date(s).
• Determines patient out-of-pocket estimates based on the patient's specific insurance plan. Notifies patients of determined expenses and establishes payment arrangements per OCR guidelines and department protocols.
• Works directly with assigned OCR physician clinics as issues and/or questions arise.
• Responds to insurance companies’ requests for information in a prompt and professional manner.
• Follows up on non-authorization claim denials promptly, exercising all options to obtain payment.
• Demonstrates consistent collection work by monitoring patient accounts for payment of surgical agreements. Follows up with patient and/or Insurance Coordinator regarding outstanding balance of payment issues.
• 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 the Business Office service line.
• Required to follow OCR and departmental policies and procedures.
• Other duties as assigned.

• High school diploma or equivalent is required.
• Minimum one year experience as Authorization and Benefits Coordinator at OCR. 
• Knowledge of medical terminology required.

Physical Requirements

•  The work environment is the typical office environment. The employee must be able to complete their work satisfactorily in an environment where there are distractions, including staff, patients, and vendors walking through and conversing, telephones ringing, conversations carrying over, and interruptions to answer questions from others.
• While performing the duties of this job, the employee is frequently required to sit and use hands to finger, handle, or feel objects, tools, or controls 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 may 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.

Benefits

• Medical, Dental, & Vision coverage
• Life and AD&D Insurance
• Short- and Long-term disability coverage
• Retirement savings and profit-sharing plan participation
• Employee Assistance Program
• Paid Holidays & Paid Time Off
• Company-sponsored events
• Annual merit increases

**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.