POSITION SUMMARY: 

Ensure timely and accurate review of Medicare related orders.

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.

·         Ensure timely and accurate review of Medicare related orders.

·         Regularly update external sales force on status of orders.

·         Critique prescriptions; chart notes: operative reports: discharge summaries: x-ray interpretations: chart note accuracy: and all other provided documentation relevant to the prescribing of an Orthofix product.

·         Critiquing is based on Medicare and Orthofix written guidelines, policies and procedures.

·         Follow formal written policy on submission of issues to Health Care Compliance for review.

·         Support and provide ongoing training to Sales Force regarding Medicare guidelines.

·         Provide verification and authorization of other insurance as required. 

·         Identify selling points utilizing payer guidelines, clinical studies, product and marketing tools.

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

·         Perform final analysis of order prior to release to billing; ensure quality and accuracy of pricing.

·         Complete in-depth analysis of payers to determine guidelines and trends

·         Identify and recommend to National Accounts contracting and medical policy opportunities.

·         Special projects as assigned.

·         Regular attendance required.

ESSENTIAL SKILLS, EXPERIENCE AND QUALIFICATIONS: 

·         Ability to effectively communicate with payers directly impacts collection efforts and the company's profit.

·         Revenue generated directly affects the compensation of the Sales Force.

·         Detail oriented with an emphasis on quality.

·         Strong anatomy and medical terminology.

·         Strong technical skills.

·         Excellent decision making, judgment and analytical skills.

·         Excellent communication skills.

·         Ability to handle multiple priorities and heavy volume.

·         Self starter with a high energy level.

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

·         PC skills in a Windows environment.

·         Minimal supervision.

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

·         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.; occasionally required to reach overhead, bend, and lift objects of up to 20 lbs.

·         Eyesight and hearing must be correctable to standard level.

·         Ability to deal effectively with specific elements of the position, such as: frequently changing deadlines, periodic heavy workloads, and dynamic business growth.