Full-Time

Non - Exempt

Pay range: $20.50 - $26.00

Reports to: Benefits and Referral Specialist

Location: Administrative Building (Louisville) – Hybrid/Remote after Training

REMOTE REQUIREMENTS:

·        Internet minimum recommendation:

o  20Mb/s down, 10Mb/s up, less than 10ms latency. Comcast offers up to 1000Mb/s down, 40Mb/s up, less than 5ms latency.

·        Computer:

o  Windows 10 or 11 with i5 processor or better, 8GB+ RAM or better, 1920x1080 resolution screen, ability to run an extra monitor if you wish.

o  Gotchas: 4K(3840x2160) may be too small of a font for some of the applications. You will have to play with your settings to read some parts of Intergy.

o  Mac with Sequoia OS or newer.

o  Virus protection on your computer. Recommend Sentinel One or Sophos.

 ***No Chromebooks, Windows 7, old Mac OS, etc. Computers must be able to update to stay secure.

Gastroenterology of the Rockies is a rapidly growing Gastroenterology practice in Boulder County and the greater Denver Metro area with eight office locations and five Ambulatory Surgery Centers.

As a Benefits and referral Specialist at Gastroenterology of the Rockies, you will play a crucial role in ensuring the seamless coordination of medical referrals, insurance authorizations and benefits.  Your responsibilities will encompass verifying the accuracy and completeness of information related to patient visits, collaborating with scheduling department staff, and facilitating effective communication with doctors, patients, and peers. Through your meticulous attention to detail and expertise in insurance processes, you will contribute to the overall efficiency and excellence of our medical practice.

Key Responsibilities:

1.      Insurance Authorization and Pre-Certification:

• Obtain and verify insurance referrals, authorizations and pre-certifications for medical procedures and services.
• Ensure timely submission of required documentation to insurance providers.
• Maintain a comprehensive understanding of insurance policies and requirements.

2.      Coordination with Scheduling Department:

• Collaborate with scheduling department staff to gather accurate patient information prior to scheduled appointments.
• Verify insurance details and ensure the completeness of necessary documentation.

3.      Documentation and Record-Keeping:

• Record and maintain detailed and accurate documentation of insurance referrals, authorizations and pre-certifications in patient records.
• Organize and file relevant paperwork for easy retrieval.
• Document office visit co-pays, deductible and or coinsurance information.

4.      Communication:

• Communicate effectively with doctors, patients, and peers to obtain and provide necessary information.
• Liaise with insurance companies to resolve any issues related to authorizations and pre-certifications.

5.      Compliance and Regulations:

• Stay informed about changes in insurance regulations and policies.
• Ensure compliance with all relevant healthcare regulations and standards.

6.      Problem Resolution:

• Proactively identify and address any issues related to insurance authorizations or pre-certifications.
• Work collaboratively with the team to find solutions to challenges that may arise.

Qualifications:

• Education: High school diploma required; additional relevant certifications or coursework in healthcare administration or a related field preferred.
• Experience: Minimum of 2 years of experience in a similar insurance specialist role within a medical practice setting.
• Strong understanding of medical insurance processes and requirements.
• Excellent communication and interpersonal skills.
• Detail-oriented with the ability to manage multiple tasks efficiently.
• Proficient in using relevant computer software and systems.

Physical Demands and Work Environment:

• This position is primarily sedentary and requires the ability to remain seated for extended periods, with occasional standing, walking, and use of a computer and standard office equipment.
• Substantial movements (motions) of the wrists, hands, and/or fingers. The worker is required to have close visual acuity to perform an activity such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.
• Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions of the position.