Prosthetic Authorization & Billing Specialist

Position Summary:  

The Prosthetic Authorization & Billing Specialist is responsible for managing all functions related to patient billing for prosthetic related services including, insurance verification, prior authorizations, claims processing, reimbursement follow-up, and collections. This role ensures accurate and timely prior authorizations and processing of claims while maintaining compliance with payer guidelines and company procedures. The specialist works closely with patients, insurance carriers, referral sources, and internal teams to support efficient revenue cycle operations and positive patient experiences.

Core Responsibilities:

Insurance Verification & Prior Authorization:

• Verify patient insurance eligibility and benefits.
• Submit and manage prior authorizations as required by insurance carriers.
• Obtain and maintain all necessary documentation required for authorization and billing.
• Understand and communicate patient financial responsibilities including copays, coinsurance, and deductibles.
• Collect patient balances and answer patient questions regarding charges and account status.
• Build proactive relationships with referral sources, physician offices, and administrative assistants.
• Perform Other duties as needed 

Billing & Claims Management:

• Collect and review all information necessary to process insurance claims and patient billing.
• Submit accurate claims in accordance with payer requirements and standard billing procedures.
• Research, correct, and re-submit rejected or denied claims.
• Prepare appeals for denied claims when necessary.
• Follow through on outstanding claims, cash applications, delinquent accounts, write-offs, and collection activities.
• Work directly with payers to resolve reimbursement and claim issues.
• Ensure patient demographic, encounter, and insurance information is entered accurately into the electronic billing system.

Revenue Cycle & Account Resolution:

• Research, administer, and resolve billing discrepancies and collection issues.
• Support resolution of self-pay balances and payment concerns.
• Maintain accurate account documentation and follow-up notes.
• Monitor aging accounts and assist with collection efforts as appropriate.

Compliance & Documentation:

• Ensure compliance with company policies, HIPAA regulations, and payer guidelines.
• Maintain confidentiality of patient and financial information.
• Ensure documentation accuracy and completeness for billing and reimbursement purposes.

Qualifications:

Required:

• High School Diploma or equivalent required.
• 2+ years of medical billing, prior authorization, or revenue cycle experience.
• Strong understanding of insurance verification, authorization, and reimbursement processes.
• Experience working with Medicare, Medicaid, and commercial insurance carriers.
• Knowledge of medical terminology, coding, and billing procedures.
• Strong math, analytical, and data entry skills.
• Excellent organizational, problem-solving, and communication skills.
• Proficiency in Microsoft Office (Word, Excel) and medical billing software systems.

Preferred:

• Orthotics & Prosthetics (O&P), DME, or specialty healthcare billing experience highly preferred.
• Experience with Nymbl or similar EMR/billing systems.
• Familiarity with denied claims management and appeals processes.

Core Competencies:

• Attention to Detail
• Time Management
• Customer Service
• Revenue Cycle Knowledge
• Communication Skills
• Problem Solving
• Accountability
• HIPAA & Compliance Awareness

*This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities and working conditions of the position. While it is intended to accurately reflect the position of activities and requirements, management reserves the right to modify, add or remove duties and assign other duties as necessary  

Benefits Offered for Eligible Employees: 

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Long & Short-Term Disability
• Life Insurance and AD&D
• Retirement Savings Plan
• Paid Time Off (PTO) & Holidays

Equal Opportunity Employer:

OPSB is proud in its commitment to creating a diverse workforce and providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, parental status, national origin, age, disability, citizenship status, genetic information or characteristics, marital status, status as a Vietnam era veteran, special disabled veteran, or other protected veteran in accordance with applicable federal, state and local laws, and any other characteristic protected by law.