Join our team at Orlando Orthopaedic Center as an Ancillary Services Coordinator, where every patient interaction counts, by ensuring ancillary services run seamlessly through order review, scheduling and prior insurance authorization.
Since 1972, Orlando Orthopaedic Center has remained independently owned and has grown to include 24 orthopaedic specialists across multiple subspecialties, many of whom are recognized leaders amongst their peers nationwide.
We have eight Orlando Orthopaedic Center locations throughout Central Florida, plus a state-of-the-art outpatient surgery center at the heart of our downtown campus located in the trendy SoDo Shopping District just south of downtown Orlando. To provide more immediate care, we have opened several orthopaedic injury walk-in clinics located throughout Orlando and the surrounding communities.
For over 50 years, our team of physicians and support staff have been getting Central Floridians back to work, back to play and back to making a difference in our community.
POSITION: Ancillary Services Coordinator
REPOSTS TO: Ancillary Operations Manager
JOB SUMMARY: Responsible for reviewing orders, scheduling, verifying insurance and obtaining prior authorization for Ancillary Services, including Magnetic Resonance Imaging (MRI), Electromyography & Nerve Conduction Studies (EMG&NCS) and Therapy (PT/OT). Responsible for generating patient estimates and reviewing them with the patient as needed. Must follow scheduling, insurance, and documentation guidelines and maintain communication with Management and the Physician Teams.
EDUCATIONAL REQUIREMENTS:
- High school diploma, required
- Advanced degree, preferred
QUALIFICATIONS AND EXPERIENCE:
- Two years of work experience in a medical office or customer service position, required
- One year of experience performing insurance verification or prior authorization, preferred
- Knowledge of medical terminology and insurance carriers/benefits, preferred
- Knowledge of practice management and electronic health record software, preferred
- Ability to perform multiple and diverse tasks simultaneously
- Strong written and verbal communication skills
- Strong attention to detail and problem-solving skills
Responsibilities include, but are not limited to, the following:
Scheduling
- Review the orders list for orders set to the “Pending” or “OOC to Schedule” status and schedule patient for the ancillary service. Contact patients within the same business day as the order was placed.
- Review all order statuses which have a blank disposition. Either attempt to schedule the patient in house or document accordingly.
- Follow Ancillary Sheet or ancillary specific scheduling guidelines for correct scheduling steps and procedures.
- Advise patients of any special instructions to follow prior to their appointment.
- Refer patients that are not candidates to schedule at OOC to an outside facility to accommodate.
- Answer all telephone calls in a polite and friendly manner, and by the third ring as often as possible; route call or take a message as needed.
- Ensure all voicemails are cleared and processed in a timely manner. All calls before 4pm should be returned prior to the end of the business day.
Pre-Certification
- Verify insurance benefits via network portal or telephone as needed.
- Input insurance benefits information within the EHR.
- Update status of order based upon authorization status.
- Obtain authorization via network portals when applicable. When not applicable, phone in the authorization request or fax as needed.
- Review and provide clinical documentation which support medical necessity information to insurance carriers as needed for prior authorization.
- Ensure the authorization status is documented and current at all times.
- For insurance benefits and prior authorizations obtained over the phone, document call reference numbers and representative names. For requests initiated over a portal, document portal use and tracking ID or reference number provided, if applicable.
- When obtaining prior authorization for Worker’s Compensation patients, identify or create the correct insurance set for the claim (i.e., direct bill carrier versus third-party administrator).
- For denied Worker’s Compensation patients, call the patient to advise the order was denied and defer to their adjustor/nurse case manager or Patient Care Team for next steps.
- For denied commercial insurance patients, call the patient to advise the order was denied and defer to their Patient Care Team for next steps. Obtain the denial letter (if available) and send an EHR message to the ordering Patient Care Team advising of the denial reason, peer-to-peer phone number and instructions, and any applicable reference number or ID.
- For denied commercial insurance patients with orders that cannot be appealed, offer the option to be self-pay for the service.
- Create insurance sets as needed for Self-Pay services or Worker’s Compensation claims to be billed to a third-party administrator.
- Contact patients with pending prior authorization no later than 4 pm the prior business day to advise their appointment needs to be rescheduled to give more time for the authorization decision to be made.
- Follow up on pending authorizations within two business days from the initial authorization request to ensure the insurance company has received the authorization request.
- Prioritize initiating prior authorizations as needed based on upcoming date of service or the insurance type.
- Continuously check the schedule for STAT or add-on appointments requiring insurance verification and prior authorization.
Therapy Clinic Support
- Schedules patient appointments; explains to patient what to bring, how to dress, potential financial obligations, provides scheduling options, follows therapy scheduling guidelines
- Calls therapy evaluation patients for the next business day to remind them of their appointment time and how to dress for their therapy session
- Greets patients in a warm and friendly manner as they arrive for scheduled appointments
- Provides patients appropriate paperwork for required signatures
- Verifies demographic information for patients, according to protocol and updates computer system as needed
- Explains applicable policies to patients and obtains signatures as needed. (i.e., Therapy Verification of Benefits, Therapy Cancelation Policy, Self-Pay Therapy Plan, etc.
- Collects and processes payments
- Ensures the necessary patient paperwork is complete and the MD is added to the Superbill before changing the EHR Status to “Ready for PT”
- Ensures patient is scheduled for follow-up Therapy visits for at least two weeks out
- Updates Authorization Tracking Log in EHR with visit date and copayment
- Collects and process payments for DME items
- Maintain ongoing communication between the therapists and therapy team. Attend all regular Branch and therapy staff meetings
- Reviews the appointment reminder report and processes cancellations as needed
- Calls any patients who No-show in order to get them rescheduled
- Requests updated physical therapy orders from the Physician Team and/or referring physician
- Processes all faxes and office therapy EMR messages within 24 hours of reception
- For workers compensation patients, faxes orders requesting updated authorizations, follows up on authorization requests and calls Nurse Case Managers or Adjusters to notify them of missed appointments. Also, faxes evaluations and status reports
- Keeps the patient reception area neat and clean at all times throughout the day
- Ensures all payments collected are posted in the Practice Management System and entered into the day sheet. At the end of each day balances transactions and submits cash report
General Administration
- Process all authorization related faxes.
- Compose Good Faith Estimates and explain the potential financial responsibility to the patients.
- Obtain retro-authorizations and assist with denials as needed.
- Communicate directly with the Revenue Cycle Department to fill any requests for additional documentation.
- Maintain detailed knowledge of practice management, electronic health record and other computer software as it relates to job functions.
- Log all denials and re-certifications.
- Abide by HIPAA Confidentiality Agreement.
- Assist with training new team members as needed.
- Complete all other duties as assigned by the Ancillary Operations Supervisor or by upper administration.
Supervisory Responsibilities
This job has no supervisory responsibilities.
Typical Physical Demands
Position requires extended sitting, some standing, bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Employee will work under stressful conditions, and work irregular hours.
Typical Working Conditions
Employees are expected to report to work in the office setting when scheduled specifically to do so by their Supervisor. Employee must work well under pressure and may be required to work flexible hours.
Pay: $16.50 - $19.50 per hour
Benefits:
- 401(k) matching
- Dental insurance
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Education:
- High school or equivalent (Required)
Experience:
- Medical office: 2 years (Required)
- Insurance verification: 1 year (Preferred)
- Medical terminology: 1 year (Preferred)
Work Location: In person
