Insurance Administrator II

Why Orthofix?
    

Guided by our organizational values – Take Ownership | Innovate Boldly | Win Together – we collaborate closely with world-class surgeons and other partners to improve people’s quality of life. At Orthofix, we want team members who build relationships and share knowledge, challenge the status quo, and deliver results every day to help us achieve our vision to be the unrivaled partner in Med Tech.  

Our global team of over 1,600 employees brings to market highly innovative, cost-effective, and user-friendly medical technologies that heal musculoskeletal pathologies for patients and the healthcare professionals who treat them. Looking to change people’s lives? Look no further.

How you'll make a difference?
Verify insurance benefits, obtain authorizations, follow up on existing accounts and negotiate pricing and coverage of Orthofix products.

What will your duties and responsibilities be?
The following are the essential functions of this position. This position may be responsible for performing additional duties and tasks as needed and assigned.

• Perform a wide variety of duties of an Insurance nature requiring initiative and a degree of judgment in solving problems

• Determine revenue amounts based on allowable, benefits, unit price, payer guidelines, co-payment and booking policy

• Verify benefits, primary, secondary, and tertiary; provide clinical and product information for the purchase of Orthofix products

• Verify, understand and communicate patient DME benefits, coordination of benefits and patient financial liability for all insurance, workers compensation and liability products (PPO, HMO, Medicare, Medicaid, Auto, Liability, etc.)

• Interpret patient clinical condition utilizing physician patient records, then comparing clinical condition to specific payer guidelines determine financial responsibility.  Effectively communicate condition to customers/payers

• Request authorization and/or retro-authorizations using the appropriate authorization template as required

• Communicate and understand authorization and/or retro-authorizations decisions, determine appropriate next steps for adverse decision following department policy.

• Back up region(s) as assigned to maintain operational order processing SLA levels.

• Ensure that order updates incorporate department standards

• Perform final analysis of order prior to release; review for accuracy and content.

• Build and maintain professional communication levels with internal and external customers and peers

• Knowledge of all work instructions, processes, guidelines and policies; engage team leadership as needed for additional training or questions

• Consistently meet and exceed SLA Operational & Quality targets with limited supervision

• Utilize and maintain department reports that provide order feedback and status

• Forward, identify, and recommend to leadership/Contract Operations contracting opportunities.

• Co-travel as available to increase/maintain relationships; attend seminars; attend region meetings.

• Work with contracting and/or leadership on pricing, authorization, guideline escalations needed to resolve account/payer issues

• Assist as needed to review accounts for final release to bill that all authorization, verification and communication efforts have been exhausted

• Strong understanding of all work instructions, processes, guidelines and policies

• Proactively suggest process improvements.  Utilize process and payer knowledge to assist in documenting ideas/requirements

• Assist peers with account resolution as needed

• Communicate to leadership any changes to payer guidelines, authorization delays, requirements, etc.

• Handle routine escalations related to revenue transactions, pricing, payer document requirements, Direct, etc.

• May be assigned to a specialized order processing team including Options Medical or Medicare

• Prioritize work assignments to meet deadlines

• Share knowledge amongst peers and management; proactively suggest process improvements

• Meet SLA Operational & Quality targets

• Special projects, as assigned

• Promote and exude a positive work environment

• Timely completion of all corporate wide and departmental training

• Understand and promote Compliance adherence

• Regular attendance required including Company and departmental meetings

What skills and experience will you need?
The requirements listed below are representative of the education, knowledge, skill and/or ability required for this position.

• 3-5 years of Medical Health Insurance experience required; 3-5 years of Orthofix Medical Health Insurance experience preferred

• Demonstrate teamwork behaviors by positively contributing to team culture while abiding by Orthofix Code of Conduct

• 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 with minimal supervision

• 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

What qualifications are preferred?
The education, knowledge, skills and/or abilities listed below are preferred qualifications in addition to the minimum qualifications stated above

• Some college preferred but will consider with proper experience

PHYSICAL REQUIREMENTS / ADVERSE WORKING CONDITIONS
The physical requirements listed in this section include, but are not limited, to the motor/physical abilities, skills, and/or demands required of the position to successfully undertake the essential duties and responsibilities of this position.  In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to allow qualified individuals with a disability to perform the essential functions and responsibilities of the position

• Regularly required to sit for extended periods of time; frequently required to stand, walk and use business equipment daily such as P.C., copier, fax, telephone, etc.; occasionally required to reach overhead, bend, and lift objects of up to 20 lbs.

• Eyesight and hearing must be correctable to standard level.

• Telephone usage will be approximately 90% daily.

• Ability to deal effectively with specific elements of the position, such as:  frequently changing deadlines, periodic heavy workloads, and dynamic business growth.

The anticipated base hourly rate for this position is $24.00  to $28.00 per hour, [plus bonus, and benefits]. The final pay offered to a successful candidate will be dependent on several factors that may include but are not limited to the type and years of experience within the job, the type and years of experience within the industry, education, etc. 

DISCLAIMER

The duties listed above are intended only as representation of the essential functions of this position.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.  The job description does not constitute an employment agreement between the employer and employee and is subject to change at the sole discretion of the employer.  Nothing in this document alters an employee’s at-will employment status.

We are committed to providing equal employment opportunities to all employees and applicants without regard to race (including traits historically associated with race, such as hair texture and protective hairstyles, including braids, locks, and twists), ethnicity, religion, religious creed (including religious dress and grooming practices), color, caste, sex (including childbirth, breast feeding, and related medical conditions), gender, gender identity or expression, sexual orientation, national origin, ancestry, citizenship status, uniform service member and veteran status, marital status, pregnancy, age (40 and over), protected medical condition (including cancer and genetic conditions), genetic information, disability (mental and physical), reproductive health decision-making, medical leave or other types of protected leave (requesting or approved for leave under the Family and Medical Leave Act or the California Family Rights Act), domestic violence victim status, political affiliation, or any other protected status in accordance with all applicable federal, state, and local laws.

This policy extends to all aspects of our employment practices including, but not limited to, recruiting, hiring, discipline, termination, promotions, transfers, compensation, benefits, training, leaves of absence, and other terms and conditions of employment.