Prosthetics Insurance Specialist

The Surgical Clinic (TSC) is Middle Tennessee’s premier multi-specialty surgical practice, dedicated to utilizing the latest medical technology while prioritizing patient care, convenience, and satisfaction. With over 40 surgeons, our patient-focused clinics are conveniently located, providing access to advanced surgical procedures close to home.

Why Join Us? At The Surgical Clinic (TSC), we believe that our people are the heart of our success. As Middle Tennessee’s premier multi-specialty surgical practice, we are committed to fostering a supportive, collaborative, and innovative workplace where every team member can thrive.

Job Description

The Prosthetic Insurance Specialist provides customer service in person as well as telephone etiquette and ensures that experiences with our office are held to a superior standard. You will also provide coverage as needed to the PSR position. This will require you to show excellent phone etiquette, assist patients, and schedule appointments. Knowing that this is a stressful time, it is important to confidently provide excellent customer service.

ESSENTIAL FUNCTIONS

• Generate RX/CMN forms from superbills using HCPCS coding.
• Submit appropriate documentation to obtain precertification, reconsiderations, or appeals when necessary.
• Create and submit insurance claims using HCPCS coding.
• Identify, understand, and effectively overturn insurance denials.
• Conduct phone follow-ups with patients who have not been seen in six months or more.
• Verify insurance coverage, with particular attention to prosthetics benefits.
• Obtain all necessary information required for billing purposes.
• Accurately maintain prosthetic-related Excel spreadsheets.
• Schedule MD justification appointments and manage clinic schedules.
• Reschedule cancelled or no-show justification appointments as needed.
• Scan patient records into the EMR system.
• Submit orders for Physical Therapy services.
• File patient data promptly upon receipt of information.
• Perform data entry, copying, faxing, and emailing as required.
• Perform other administrative duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES

• Knowledge of insurance verification and authorization processes.
• Knowledge of prosthetic billing requirements, including HCPCS coding.
• Strong customer service and communication skills to assist patients and provide support during the prosthetic care process.
• Strong attention to detail and organizational skills to manage documentation, research claim denials, and patient records.
• Ability to manage multiple priorities, including scheduling, follow-up, and administrative coordination in a fast-paced environment.
• Proficiency in EMR systems, Microsoft Office applications, and data tracking tools to support operational efficiency.

EDUCATION & EXPERIENCE

• High School Diploma or GED is required.
• A minimum of 2 years’ experience in customer service required, medical office experience preferred.
• Prosthetics Medical Terminology is required.
• Electronic Medical Records experience required.
• Ability to maintain confidentiality according to HIPAA guidelines is required.
• Excellent verbal and written communication skills are preferred.

PHYSICIAL REQUIREMENTS

To conduct this position properly, applicants must be able to complete the following list of physical tasks. Reasonable accommodation will be available for those individuals with disabilities and are not able to complete the following tasks.

• Sitting and standing for prolonged periods of time
• Lifting objects, possibly weights in excess of 30 pounds.
• Bending, reaching, and twisting
• Ability to assist and support patients in transfer from exam rooms, out of wheelchairs, onto exam tables, during the exam process, etc.
• Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus as needed.

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