National Spine & Pain Centers

Compensation

Full Description

Position Summary The Account Representative Level II provides leadership, direction, and support for delivering world class results while providing efficiency and effectiveness for the Revenue Cycle operations within the Revenue Cycle function of National Spine and Pain Centers (NSPC). This includes related activities specific to obtaining and processing pre-authorization requests from insurance companies for medical services. This involves reviewing patient records, verifying insurance benefits, and communicating with providers, insurance companies, and patients to ensure necessary approvals are obtained in a timely manner. The account representative ensures that all requirements are met for reimbursement and that services are authorized before they are provided. The Account Representative Level II will actively look for opportunities to maximize revenue throughout the system to transform the patients over all care with a focus on improving both the patient experience and satisfaction as well as providing accountability for strategic business units that impact patient experience and service pillars of the organization. The Account Representative Level II will exhibit behaviors consistent with the standards for organizational values of National Spine and Pain Centers. Demonstrates actions consistent with the National Spine and Pain Centers "expectations" as duties are performed daily. Span of control includes the following areas: • Office Based Authorizations/ Surgical Authorizations • Denial Resolution / Appeals Requirements Duties and Responsibilities • Obtain prior authorizations for services and procedures, as required by insurance payers. • Verify insurance benefits and eligibility prior to scheduled services. • Document and update authorization status and details in the electronic medical record system. • Communicate with providers, clinical staff, and patients regarding authorization requirements and statuses. • Follow up on pending authorizations to ensure approvals are received prior to service delivery. • Maintain up-to-date knowledge of payer policies and guidelines. • Assist with appeals or denials as needed. • Contact patients 72 hours prior to the appointment if there is no approval on file. Qualifications and Skills • High school diploma or equivalent required; associate degree preferred. • Minimum of 1-2 years of experience in medical insurance verification, prior authorization, or related healthcare administrative roles. • Strong knowledge of insurance plans, payer guidelines, and medical terminology. • Familiarity with CPT, ICD-10 codes, and medical terminology. • Excellent communication and customer service skills. • Detail-oriented with strong organizational skills. • Proficiency with electronic health record systems and Microsoft Office suite. • Ability to work independently and as part of a team in a fast-paced environment. Preferred Qualifications • Experience with specific specialties (e.g., orthopedics, neurology, radiology, pain management). • Knowledge of utilization management guidelines. • Bilingual skills may be helpful in certain regions. Working Conditions • Remote based position. Remote employees will perform their job duties in areas free from background noise and from distraction. • The work area must protect the confidentiality of the work the employee is performing. • Regular use of office equipment. Physical Requirements • Extensive and regular periods of sitting, standing, bending, walking, seeing, talking, and listening. • A full range of body motion including complete manual and finger dexterity, as well as effective hand-eye coordination. • Adequate visual acuity including ability to read information. • An occasional requirement to reach with hands/arms, stoop, kneel, or crouch. • An occasional requirement to push, pull, lift and/or move up to 10 pounds. Salary Description $19 - $21 per hour