Why Orthofix?

We are a leading global spine and orthopedics company with a premier portfolio of biologics, innovative spinal hardware, bone growth therapies, specialized orthopedic solutions and a leading surgical navigation system. Our combined company is over 1,600 strong, with products distributed in 68 countries worldwide and a global R&D, commercial and manufacturing footprint, and this is just the beginning!

Come join our global team of dedicated professionals who through their extraordinary efforts demonstrate every day their commitment to our mission of improving the lives of patients. At SeaSpine and Orthofix our culture is built around Integrity and the core beliefs we live by: Exceed Expectations, Work Together, Be Respectful, Get Lean and Have Fun!

POSITION SUMMARY:

Verify insurance benefits, obtain authorizations, follow up on existing accounts and negotiate pricing and coverage of Orthofix products.

DUTIES AND RESPONSIBILITIES (essential functions of position):

• 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

ESSENTIAL SKILLS, EXPERIENCE AND QUALIFICATIONS:

• 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

NONESSENTIAL SKILLS, EXPERIENCE AND QUALIFICATIONS (not necessary but preferred):

• Some college preferred but will consider with proper experience

PHYSICAL DEMANDS AND WORK CONDITIONS:

• 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.

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.