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Prior Authorization Specialist

Company: Zimmer US
Location: Warsaw
Posted on: November 22, 2021

Job Description:

Job SummaryZimmer Biomet is a world leader in musculoskeletal health solutions. Our team members are part of a company with a heritage of leadership, a focus on shaping the future, and a mission dedicated to alleviating pain and improving the quality of life for people around the world.Responsible for the day-to-day processes to verify patient eligibility and benefits (insurance verification) as well as providing preauthorization services for Zimmers Gel-One and Visco 3 products. This position will communicate daily with HCPs and payers to achieve the aforementioned. The position will be required to keep appropriate documentation, utilize systems and tools provided and communicate with other members of the team as issues and trends are identified. Other duties may be assigned.Principal Duties and ResponsibilitiesManage requests for insurance verification and benefits determination for patients receiving specific orthopedic services from health care professionals (HCPs). Utilize available resources and systems to obtain insurance benefits information for ordered services in a timely manner including, insurance provider services department, health care professionals and referral resourcesConduct preauthorization services for patients receiving specific orthopedic services from HCPs. Ensure compliance with Zimmer guidelines and codes of conductSafeguards and preserves the confidentiality of patient identifiable information in accordance with HIPAA Protected Health Information (PHI) policy. Ensure that proper documentation of information release and business associate status is executed before receiving HIPAA Protected Health InformationProvide professional service to HCP customers, responding to requests on a timely basis and reporting back results of insurance verification and/or preauthorization both verbally and in writingMaintain and update database system with health care professional and patient information as defined in insurance verification and preauthorization processesAssist in generating reports and presentations using Microsoft Word, Excel and Powerpoint.Provide back-up to Reimbursement Hotline function as necessaryThis is not an exhaustive list of duties or functions and may not necessarily comprise all of the "essential functions" for purposes of the ADA.Expected Areas of CompetenceKnowledge or understanding of commercial insurance, Medicare, Medicaid, and other governmental and private insurance products, specifically the verification and authorization processesMedical terminology and health insurance background requiredUnderstanding on health insurance concepts and benefit design requiredExcellent customer service skills, analytical problem solving skills, strong written and verbal communication skills, professional telephone manner, well organized, experience using Microsoft Office toolsEducation/Experience RequirementsHigh School degree required,3-5 years of prior insurance verification and preauthorization work or related experience in a health care environment, requiredExperience in health insurance customer service department or working in a provider setting with these assigned responsibilities preferredPrefer experience working in orthopedics, or musculoskeletal settingPrior working experience in a device company would be a plusTravel RequirementsNoneAdditional InformationEOE/M/F/Vet/DisabilityAt Zimmer Biomet, we believe in The Power of Us, which means that we are stronger together. We are committed to creating an environment where every team member feels included, respected, empowered, and celebrated.As a Zimmer Biomet team member, you will share in our commitment to providing mobility and renewed life to people around the world. This is why we offer you a competitive rewards package that includes medical, dental, vision, life and disability insurance, wellness incentives, employee assistance programs as well as paid time off for vacation and holidays.Compensation Range 35-45KEqual Opportunity Employermin

Keywords: Zimmer US, South Bend , Prior Authorization Specialist, Other , Warsaw, Indiana

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