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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:

• Performing timely and accurate insurance and benefits verification, and pre-certification of Radiology imaging.
• Coordinating with clinic staff to add and update insurance and perform verification and reverification of insurance benefits.
• Determining eligibility, coverage details, and benefits using online resources or phone calls with the insurance company.
• Communicating status of verification/authorization process with appropriate team members in a timely and efficient manner.
• Documenting verification details for all Radiology Authorization services in the patient’s record.
• Verifying completeness and accuracy of all information prior to resolving tasks in the work queue.
• Working productively and efficiently from a task-based work queue.
• Acting as liaison between clinical staff, patients, and insurance by informing all parties of coverage issues.
• Contacting insurance companies to determine preauthorization requirements for outpatient imaging studies.
• Reviewing and submitting clinical information to support medical necessity of Radiology orders.
• Analyzing, investigating, and resolving all authorization denials and peer-to-peer requests.
• Filing appeals and reconsiderations for denied authorizations.
• Utilizing reports to initiate preauthorization on Radiology scans and communicate across functional areas.
• Identifying problems or trending issues and providing suggestions for findings and resolutions.
• Responding timely to emails and telephone messages as appropriate.
• Regularly meeting with Practice Manager to discuss and resolve verification issues or preauthorization obstacles.
• Abiding by the Health Insurance Portability and Accountability Act (HIPAA) when handling any and all protected health information (PHI).

Qualifications

• High school diploma (or equivalent) is required; collegiate education preferred.
• Hematology/Oncology Authorization experience a plus.
• Three + years of medical office experience preferred.
• Demonstrated skills in problem solving, attention to detail, and effective written and verbal communication skills.
• Advanced technical skills including PC and MS Outlook.
• Advanced knowledge of health insurance benefits including In-network & out-of-network services.
• Advanced knowledge of CPT, HCPCs, and ICD-10 codes.
• Advanced knowledge of medical terminology and business office processes.
• Strong interpersonal skills.
• Customer service experience and the ability to prioritize and work accurately.
• Must be able to sit 8 hours/day; work may be stressful at times.

Requirements

• Precertifications completed within three to five business days before date of service.

Benefits

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance