Insurance Administrator
ORTHOFIX Inc
 Lewisville, TX

Position Description

Why Orthofix?

Come join our global team of dedicated professionals who through their extraordinary efforts demonstrate every day their commitment to our mission of improving the lives of patients. At Orthofix our culture is built around Integrity and the core beliefs we live by: Exceed Expectations, Work Together, Be Respectful, Get Lean and Have Fun! As an Orthofix employee, you will become an integral part of our culture by continually demonstrating the highest level of integrity and our beliefs while making an impact to our vision “To be a highly respected global orthopedic and spine company that delivers exceptional value to our patients, customers, team members, partners and shareholders.“

Insurance Administrator

How you'll make a difference?

Orthofix's Insurance Administration Team is responsible for verifying patient insurance benefits coverage for our bone growth therapy devices.

What will be your Duties and Responsibilities?

  • Perform a wide variety of duties of an Insurance nature requiring initiative and a degree of judgment in solving problems.
  • Research and provide current guidelines and medical policies to Insurance Administration. Communicate any changes to management.
  • Build and maintain professional communication levels with corporate 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.
  • 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 Corporate 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, validation, and weekly analysis of UTB and 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 the 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.
  • Stay current with products, competition, and clinical studies.
  • Reinforce training and insurance follow up to maximize company profitability.
  • Co-travel as available to increase/maintain relationships; attend seminars; attend region meetings.
  • Special projects, as assigned.
  • Timely completion of all corporate wide and departmental training.
  • Understand and promote Compliance adherence.
  • Regular attendance required.

What skills you'll need?

  • 1-2 years of Medical Health Insurance experience preferred or 1-2 years of Orthofix Order to Cash experience
  • Demonstrate teamwork behaviors by positively contributing to team culture while abiding by Orthofix Code of Conduct
  • Strong time management, organizational, verbal and written skills
  • Strong knowledge of insurance companies and associated contract types (i.e., HMO, Auto, PPO, POS)
  • Ability to handle multiple priorities at moderate assignment volume while meeting all deadlines and maintaining high standards of work quality
  • Detail oriented with emphasis on quality and timeliness
  • Ability to promote logic/thought.
  • Ability to adapt to fast changing priorities with ease and confidence while supporting management decisions.
  • Project a professional image.
  • Excellent knowledge of anatomy, products and related clinical studies.
  • Innovative thinker with good judgment, analytical and decision-making skills.
  • Excellent work ethic - supervision is minimal, yet assistance will be readily available as needed from leadership team
  • Strong utilization of computer skills. Able to run various programs with ease.
  • 2 year College degree preferred.

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.

Orthofix complies with all applicable federal, state, and local laws regarding equal employment opportunities (EEO) to all employees and applicants for employment. Orthofix makes its employment decisions without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other status protected by law. In addition to federal law requirements, Orthofix complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has employees. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.