Job Purpose:

The VOB Specialist is responsible for verifying insurance coverage and obtaining authorization and estimates for services patients are receiving in clinic, rehabilitation, or surgical setting.

Primary Duties and Responsibilities:

• Ensures accurate documentation of patient’s insurance coverage in EMR, making necessary revisions and contacting the patient for additional information as needed

• Obtains authorization or approval from each insurance company within accepted timeframe and prior to patient’s procedure or scheduled date of service

• Ensures authorization documentation is received from each insurance company and reviews for accuracy

• Documents denied authorizations in patient chart, coordinating the peer-to-peer process with scheduling team and/or begins the appeal process

• Costs and approves cases for ambulatory surgery center

• Reviews daily eligibility report to proactively address insurance verifications needed before patient appointments

• Produces estimates of patient responsibility as requested by patients or as required by the No Surprises Act, distributes the estimates and acts as primary contact for estimate questions.

• Answers the Verification of Benefits ring group number and assists or directs patients as necessary

• Produces patient estimates in accordance to the requirements of the No Surprises Act and as needed per patient request or as OrthoIllinois requires

Competencies:

• Service: We align our actions and decision making with the organization’s guiding platform keeping our patients at the center of all we do.

• Change Agent: We support and contribute to positive change in the organization.

• Communication and Interpersonal Relations: We communicate honestly and with compassion to build connections with our patients and each other.

• Effectiveness: We take ownership of work, doing the right thing for our customer and doing it well.

Organizational Culture:

All OrthoIllinois employees focus on service by putting the mission, vision, and value statements into practice and using the guiding principles of Compassion, Respect, Trust, Integrity, Innovation, Education Fiscal Responsibility, Practice Independence, Accountability, and Empowerment to direct their interactions and decision making. Employees promote and model the service standards to create lasting impressions, extraordinary moments, exceptional on-stage experiences, and meaningful and compassionate connections.

Education and Experience Requirements:

• High School Diploma or GED

• A minimum of one year of experience in a similar position and/or performing similar tasks

• Prior experience working in a medical office setting or with insurance claims preferred

• Basic working knowledge of Microsoft and Google Suites

• Basic working knowledge of EMR systems preferred

Environmental/Working Conditions:

Working environment is in an office/clinic setting.

Physical/Mental Demands:

• Sit, stand, walk, stoop or kneel, crouch or crawl, and climb stairs for long periods of time

• Requires lifting, carrying and/or moving objects in a manner consistent with most office environments (generally, no more than 10 pounds on a frequent basis and 20 pounds on an occasional basis)

• Possess full range of motion in shoulders and arms, including reaching above or below the shoulder

• Finger dexterity; the ability to twist hands/wrists repetitively

• Vision (e.g., depth perception, color vision, strong vision up close), hearing (e.g., high pitch sounds, soft or distant sounds)

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.