Insurance Administrator

Role Overview

• Perform a wide variety of duties of an Insurance nature requiring initiative and a degree of judgment in solving problems.
• Research and provide current guidelines and medical policies to Insurance Administration.
• Communicate any changes to management.
• Build and maintain professional communication levels with corporate accounts, territory managers, region managers, case managers, adjustors, medical directors, business partners, and internal management.
• Back up region(s) as necessary to maintain desired turnaround time for order processing.
• Fax accurate and thorough pre-authorization request letters.
• Ensure that order updates incorporate department standards.
• Perform final analysis of order prior to release; review for accuracy and content.
• Forward, identify, and recommend to Corporate Accounts contracting opportunities.
• Determine revenue amounts based on allowable, benefits, unit price, payer guidelines, co-payment and booking policy.
• Perform daily analysis of call sheet, validation, and weekly analysis of UTB and open order report.
• Support the sales force on a daily basis: communication, updating orders, assisting, directing, and providing positive direction and feedback.
• Critique prescriptions, letters of medical necessity and/or chart notes for consistent and complete medical information.
• Verify benefits, sell medical necessity, negotiate coverage and pricing for the purchase of Orthofix products.
• Communicate with internal and external associates regarding order process and payer trends (implement appropriate corrective action as needed).
• Participate and assume an active role in department solutions and processes.
• Communicate and escalate business concerns to management when appropriate.
• Reinforce department standards, support through positive and solution-oriented communication.
• Utilize and maintain department reports that provide order feedback and status.
• Prioritize work assignments to meet deadlines.
• Provide timely feedback and action to ensure company and patient requirements are met and addressed with a sense of urgency.
• Stay current with products, competition, and clinical studies.
• Reinforce training and insurance follow up to maximize company profitability.
• Co-travel as available to increase/maintain relationships; attend seminars; attend region meetings.
• Special projects, as assigned.
• Timely completion of all corporate wide and departmental training.
• Understand and promote Compliance adherence.

Requirements

• 1-2 years of Medical Health Insurance experience preferred or 1-2 years of Orthofix Order to Cash experience
• Strong time management, organizational, verbal and written skills
• Strong knowledge of insurance companies and associated contract types (i.e., HMO, Auto, PPO, POS)
• Ability to handle multiple priorities at moderate assignment volume while meeting all deadlines and maintaining high standards of work quality
• Detail oriented with emphasis on quality and timeliness
• Ability to promote logic/thought
• Ability to adapt to fast changing priorities with ease and confidence while supporting management decisions
• Project a professional image
• Excellent knowledge of anatomy, products and related clinical studies
• Innovative thinker with good judgment, analytical and decision-making skills
• Excellent work ethic
• supervision is minimal, yet assistance will be readily available as needed from leadership team
• Strong utilization of computer skills
• Able to run various programs with ease.
• 2 year College degree preferred.

Benefits

• Regular attendance required.