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Role Description
The Radiology Authorization Specialist plays a critical role in obtaining pre-certification of Radiology imaging for PCI patients. This position involves:
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Performing timely and accurate insurance and benefits verification, and pre-certification of Radiology imaging.
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Coordinating with clinic staff to add and update insurance and perform verification and reverification of insurance benefits.
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Determining eligibility, coverage details, and benefits using online resources or phone calls with the insurance company.
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Communicating status of verification/authorization process with appropriate team members in a timely and efficient manner.
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Documenting verification details for all Radiology Authorization services in the patient’s record.
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Verifying completeness and accuracy of all information prior to resolving tasks in the work queue.
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Working productively and efficiently from a task-based work queue.
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Acting as liaison between clinical staff, patients, and insurance by informing all parties of coverage issues.
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Contacting insurance companies to determine preauthorization requirements for outpatient imaging studies.
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Reviewing and submitting clinical information to support medical necessity of Radiology orders.
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Analyzing, investigating, and resolving all authorization denials and peer-to-peer requests.
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Filing appeals and reconsiderations for denied authorizations.
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Utilizing reports to initiate preauthorization on Radiology scans and communicate across functional areas.
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Identifying problems or trending issues and providing suggestions for findings and resolutions.
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Responding timely to emails and telephone messages as appropriate.
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Regularly meeting with Practice Manager to discuss and resolve verification issues or preauthorization obstacles.
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Abiding by the Health Insurance Portability and Accountability Act (HIPAA) when handling any and all protected health information (PHI).
Qualifications
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High school diploma (or equivalent) is required; collegiate education preferred.
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Hematology/Oncology Authorization experience a plus.
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Three + years of medical office experience preferred.
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Demonstrated skills in problem solving, attention to detail, and effective written and verbal communication skills.
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Advanced technical skills including PC and MS Outlook.
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Advanced knowledge of health insurance benefits including In-network & out-of-network services.
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Advanced knowledge of CPT, HCPCs, and ICD-10 codes.
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Advanced knowledge of medical terminology and business office processes.
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Strong interpersonal skills.
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Customer service experience and the ability to prioritize and work accurately.
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Must be able to sit 8 hours/day; work may be stressful at times.
Requirements
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Precertifications completed within three to five business days before date of service.
Benefits
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401(k)
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Dental insurance
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Employee assistance program
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Employee discount
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Health insurance
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Life insurance
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Paid time off
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Referral program
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Vision insurance