Insurance

• Verify patient insurance eligibility, benefits, and coverage prior to scheduled services.
• Review and interpret insurance plans, including out-of-network benefits, deductibles, coinsurance, copays, and out-of-pocket responsibilities.
• Obtain prior authorizations and pre-certifications as required by insurance carriers.
• Contact insurance companies to resolve eligibility, coverage, and authorization issues.
• Accurately document and update patient insurance information within the electronic medical record (EMR) system.
• Educate patients regarding their insurance benefits and anticipated financial responsibility.
• Collaborate with providers, scheduling staff, and the medical billing team to ensure accurate and timely claims processing.
• Maintain compliance with HIPAA regulations and company policies regarding patient confidentiality.
• Perform additional duties as assigned to support departmental and organizational objectives.

Insurance Verification Specialist

Credentialing Specialist

• Reviews and processes applications for provider privileges
• Focuses on follow-up, follow through and achievement of stringent deadlines
• Reviews and analyzes provider credentialing file for completeness, accuracy, issues, and changes
• Responds to provider inquiries received by letter, phone, or internal departments
• Administers re-credentialing of Physicians and CRNAs
• Complies with HIPAA regulations
• Assists with other special projects and process redesign initiatives as requested

Medical Billing and Coding

• Review operative reports and clinical documentation to assign appropriate CPT, ICD-10-CM, and HCPCS Level II codes.
• Ensure accurate capture of modifiers and adherence to payer-specific coding guidelines.
• Verify that all coded information supports medical necessity and aligns with regulatory requirements (e.g., CMS, AMA, and payer-specific policies).
• Query physicians for clarification or additional documentation when necessary.
• Maintain current knowledge of coding guidelines, compliance requirements, and regulatory updates.
• Collaborate with billing, compliance, and revenue cycle teams to resolve coding and claim issues.
• Participate in internal audits and quality assurance reviews.
• Meet productivity and accuracy benchmarks as established by the department.
• Protect patient confidentiality in accordance with HIPAA standards.

Surgical Coder

Sales

• Be present via TEAMS during discussions with patients after they have seen the provider to help patient understand PRM Protocol and their financial responsibility based on their insurance.
• When necessary, be present via TEAMS to go over cost with patients again for a second round of treatment.
• Ensure patients understand the PRM Protocol and the financial cost to them.
• Help patient understand why treatment is needed and offer options to help them afford it.
• Present case fees and financial options to patients to facilitate the decision to say “yes.”
• Present or co-present the treatment plan and consent.
• Educate patients, as necessary, regarding their insurance benefits.
• Determine medical benefit eligibility, limitations, and payment estimates necessary to facilitate financial arrangements.
• Ensure patients are fully informed on their financial obligations.
• Ask satisfied patients for a referral/online testimonial.
• Proactively communicate with the Team so they know whether patient has decided to move forward with treatment and the financial decision made.
• Track patients who have been spoken to and the outcome of that discussion for administration.

Insurance Verification Specialist

Credentialing Specialist

Surgical Coder

Treatment Plan Coordinator, Sales Experience