Insurance Authorization Specialist in Plano, Texas at Plano Orthopedic & Sports Medicine Center

About Plano Orthopedic & Sports Medicine Center

We believe in the power of kindness, the importance of teamwork, and the value of each patient’s journey. At Plano Orthopedic & Sports Medicine Center, we pride ourselves on our 45+ years of service to the community, delivering exceptional healthcare with a personal touch. Our culture is built on the core values of integrity, respect, compassion, service, a positive attitude, and teamwork. Here, you'll find more than a job, you'll find a supportive environment where your contributions truly matter. If you thrive in a dynamic, patient-centered environment and take pride in delivering exceptional service, this is the organization for you!

About the role

We are seeking an Insurance Authorization Specialist to join our team. The ideal candidate will play a part of the patient’s experience and assist in facilitating when the physician determines that the patient is a candidate for surgery. The Authorization Specialist works with the scheduling coordinators and insurance carriers to obtain authorization, coordinate peer-to-peer calls, generate and collect surgery estimates, plus any additional steps needed for their procedure.

What you'll do

• Manage and maintain accurate medical records in compliance with HIPAA regulations.
• Perform insurance verification to ensure coverage and eligibility for services provided.
• Collaborate with managed care organizations to facilitate patient care and streamline processes.
• Verify insurance coverage and precertification for patient appointments including copay, deductible, and co-insurance
• Determine patient fee responsibility electronically and/or by phone
• Update insurance information for existing patients
• Communicate effectively with patients, providers, and insurance companies regarding medical terminology and procedures.
• Maintain organized office operations to support the overall efficiency of the medical practice.
• Navigate insurance carrier portals
• Outbound pre-certification calls
• Detail and ability to multi-task
• Maintain the daily worklist through applicable applications
• Maintain the daily surgery denial worklist

Qualifications

• Knowledge of HIPAA regulations and commitment to patient confidentiality.
• Experience with insurance verification processes and managed care systems.
• Familiarity with medical terminology and record management systems.
• Strong organizational skills with attention to detail in a fast-paced environment.
• Excellent communication skills, both written and verbal, to interact effectively with patients and healthcare professionals.
• Previous experience in a medical office or related field is a plus but not required.

Join us in making a difference in patient care through your expertise as a Specialist!