Utilization Review Collection Specialist

At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization.  OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement. To learn more about Team OC please visit  https://www.orthocarolina.com/about-us 

We are currently searching for a Utilization Review (UR) Specialist to join our team in the OrthoCarolina Business Office in Charlotte.   

The Utilization Review (UR) Specialist MRI confirms the eligibility, benefits, precertification and pre-collect for all commercial and self-pay patients scheduled for a MRI at an OrthoCarolina MRI Site. Prior authorization experience is required. Pre-collections will include unpaid, true patient current balance, and patient's estimated financial responsibility for MRI services. Identifies and corrects internal problems within assigned accounts to expedite payments from insurance companies. Serves as liaison between patient, insurance company, physician and facility. The position involves a large volume calling patients and insurance companies. Substitutes in other areas of the business office as needed.

Essential Functions: 

• Obtains eligibility, benefits and prior plan approvals from insurance carriers
• Pre-collects for medical services
• Takes patient’s calls related to financial accounts
• Works closely with patients and insurance companies to get accounts paid
• Answers patient and insurance correspondence
• Provides insurance company representative with information needed to receive payment on accounts
• Posts patient payments and/or adjustments to the proper patient account
• Identifies overpayments on accounts and ensures that refunds are executed promptly

Employee Type

Regular

Qualifications

Skills

Healthcare Management, Healthcare Operations, Medical Billing, Medical Record Reviews, Medical Records Management, Medical Terminology, Patient Care, Patient Communications

Education

Certifications

Language

Work Experience