POSITION SUMMARY: 

Verify insurance benefits, sell medical necessity, and negotiate pricing and coverage of Orthofix products.

DUTIES AND RESPONSIBILITIES (essential functions of position): 

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

·         Perform a wide variety of duties of an Insurance nature requiring initiative and a degree of judgment in solving problems.

·         Provide direction and work guidance to increase department efficiency and overall company profitability.

·         Build and maintain professional communication levels with national accounts, territory managers, region managers, case managers, adjustors, medical directors, business partners, and internal management.

·         Back up region(s) as necessary to maintain desired turnaround time for order processing.

·         Co-travel as available to increase/maintain relationships; attend seminars; attend region meetings.

·         Fax accurate and thorough pre-authorization request letters.

·         Ensure that order updates incorporate department standards.

·         Perform final analysis of order prior to release; review for accuracy and content. 

·         Forward, identify, and recommend to National Accounts contracting opportunities. 

·         Determine revenue amounts based on allowable, benefits, unit price, payer guidelines, co-payment and booking policy. 

·         Perform daily analysis of Call Sheet and weekly analysis of Open Order report.

·         Support the sales force on a daily basis: communication, updating orders, assisting, directing, and providing positive direction and feedback. 

·         Critique prescriptions, letters of medical necessity and/or chart notes for consistent and complete medical information. 

·         Verify benefits, sell medical necessity, negotiate coverage and pricing for purchase of Orthofix products.

·         Communicate with internal and external associates regarding order process and payer trends (implement appropriate corrective action as needed).

·         Participate and assume an active role in department solutions and processes. 

·         Communicate and escalate business concerns to management when appropriate.

·         Reinforce department standards, support through positive and solution-oriented communication.

·         Utilize and maintain department reports that provide order feedback and status.

·         Prioritize work assignments to meet deadlines. 

·         Provide timely feedback and action to ensure company and patient requirements are met and addressed with a sense of urgency. 

·         Generate revenue that directly affects the compensation of the Sales Force. 

·         Take initiative to stay current with products, competition, and clinical studies.

·         Reinforce training and insurance follow up to maximize company profitability.

·         Special projects, as assigned.           

·         Regular attendance required.

ESSENTIAL SKILLS, EXPERIENCE AND QUALIFICATIONS: 

·         Basic knowledge of insurance companies and associated contract types (i.e., HMO, Auto, PPO, POS).

·         Above average organization skills to manage high volume of orders.

·         Ability to follow-up promptly and timely. 

·         Excellent sales and negotiation skills. 

·         Ability to provide product information to insurance companies to purchase product.   Primary challenge lies in persuading insurance companies to pay for the product. 

·         Detail oriented with emphasis on quality. 

·         Ability to promote thought/logic.

·         Ability to motivate, cultivate, and support colleagues, including the sales force, in a fast changing environment.  Encourage questions and clarification.

·         Ability to adapt to fast changing priorities with ease and confidence while supporting management decisions.

·         Project a focused and professional image.

·         Strong verbal and written communication skills required in dealing with both internal and external customers.

·         Strong knowledge of anatomy, products and related clinical studies.

·         Excellent technical skills to effectively navigate in-house systems.

·         Innovative thinker with good judgment, analytical and decision-making skills.

·         Strong PC skills in a Windows environment.

·         Self-starter.  Must have ability to meet department standards with minimum supervision.

·         Ability to work independently or as part of a team. 

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

·         2 year College degree preferred.

SUPERVISORY RESPONSIBILITIES:

·         N/A

PHYSICAL DEMANDS AND WORK CONDITIONS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

·         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.

·         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.

Please apply online directly at:

http://hostedjobs.openhire.com/epostings/submit.cfm?fuseaction=app.dspjob&jobid=303068&company_id=15578&jobboardid=24