Job Description

This is an in-office position. Please do not apply if you are only seeking remote or hybrid roles.

The Case Coordinator role involves verifying, negotiating, and pre-authorizing contracted payors for various types of insurance, including group health, Medicare, managed care, workers' compensation, personal injury, and governmental payor patient referrals. This position requires specialized knowledge to modify existing methods, solve problems, and complete tasks of significant scope and complexity. Work is typically performed under general direction with periodic review upon completion.

Essential Duties and Responsibilities:

• Process new orders promptly: All orders received by 12:00 pm PT should be processed on the same day (Monday-Friday, excluding holidays),
• Review and confirm documentation: Ensure all medical records and prescriptions meet company guidelines and payor standards for medical necessity.
• Insurance verification and prior authorization: Verify insurance benefits and initiate prior authorization when necessary.
• Communicate with adjustors: Confirm active claims, accepted body parts, preferred vendors, required documents, and contact information.
• Maintain positive patient relationships: Develop and sustain professional relationships, communicate effectively, and manage patient expectations.
• Initiate patient communication: Complete introductory calls within 24 hours of receiving orders to discuss authorization, benefits, co-pays, and timelines with patients.
• Provide product information: Emphasize product features, quote prices, discuss payment options, and explain insurance coverage for third-party reimbursement.
• Coordinate payment plans: Assist patients with specialized co-payments, deductibles, and payment plans.
• Stay updated and implement improvements: Stay informed about industry changes, implement process improvements, and meet department and company goals efficiently.
• Maintain ethical behavior and professionalism: Adhere to company policies, handle communications diplomatically, and manage stress professionally.

Education/Experience:

• High School Diploma/GED
• Associate's Degree-preferred
• Additional 2+ years related experience or equivalent of education plus directly related education, training and experience

QUALIFICATIONS:

• Strong keyboarding skills with experience in data entry or document processing
• 2+ years experience processing orders in a healthcare workplace environment
• 2+ years experience conducting insurance verifications
• Solid understanding of insurance Explanations of Benefits (EOB's)
• Highly proficient in software such as Word, Excel, PowerPoint and other standard MS Office Programs
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, decimals, and percentages

PREFERRED QUALIFICATIONS:

• Preferred Bi-Lingual Spanish

Physical and Mental Demands:

• Typically interacts with staff, peers, senior management and external customers
• Ability to handle moderate to high stress
• Regularly required to sit, stand, move about, stoop, bend, reach, finger and grasp and to move and/or lift up to 20 pounds
• Regularly must see and read computer displays and reports, PDA displays & cell phone displays
• Must regularly type and or enter data using computer keyboards.

Certificates and Licenses:

• No special certificates, licenses or registrations are required

Work Environment:

The work environment varies between that of a typical office setting with controlled temperature and humidity and a typical automobile interior, traffic and noise associated with commuting, along with typical patient home environments for short durations. Ambient noise levels are consistent and generally low to moderate.

VQ Orthocare is an Equal Opportunity Employer and participates in E-Verify.