Authorization & Accnt Verification Specialist

2 weeks ago

Shelton, United States Advanced Radiology Consultants Full time
Job DescriptionJob Description

Join our Culture of Caring

Advanced Radiology is one of the largest independent radiology practices in the tri-state area with the most experienced radiologists. We look for team members who want to grow and be professionally challenged, while enjoying a rewarding, caring and friendly environment.

Schedule: Monday-Friday 8:30am-5pm

Position Summary:

An Authorization & Account Verification Specialist reviews radiology orders to verify demographic information, insurance eligibility, review prior-authorization requirements, initiate or verify authorization for requested examination CPT code (when applicable) by insurance, third party liability or other and follow medical policies when applicable. Entering complete and accurate information in the patients account.

Essential Job Duties and Responsibilities:

  • Review requested radiology order for patient demographic data, insurance/billing information, requested CPT and clinical information
  • Ensure all patient demographic and insurance information is current and accurate:
    1. Utilizing EPIC EMR, referring office and/or patient to verify and update patient demographic data and insurance coverage, real-time eligibility, commercial insurance or third party websites, telephone verification or both to verify patient’s coverage and benefits.
  • Verify prior authorization requirements for requested CPT by covering carrier
    1. Obtain pre-authorizations on high modality imaging requests
      • Conduct a thorough review of all documentation submitted to support diagnostic imaging procedure; including script review from referring physician, detailed review of EMR and/or clinical information submitted by referring physician and review of patient insurance information.
      • Enters detailed notes regarding communication with insurance carriers and/or health care providers and steps taken in authorization process.
    2. Verify referring office provided prior-authorization by patient, date of birth, referring provider, CPT and rendering company and/or location
  • Accurate and timely communication with needed staff on authorization issues.
    1. Communicates regularly with insurance companies, health care providers, internal scheduling department, front desk coordinators and clinical staff at sites; on any exams that require clinical review and/or denials from insurance carriers.
  • Responds to telephone, electronic and in person inquires and complaints.
  • Thorough review of scheduled CT, MR, NM, PET, Doppler US patients to ensure accurate and timely receipt of demographic, insurance and clinical information required for the patient’s examination.
  • Maintains positive relations and interactions with insurance companies, referring offices, patients and internal ARC staff.
  • Demonstrates initiative in problem solving and resolving customer satisfaction issues.
  • Audits their own work to ensure quality and reports safety or quality events
  • Attends meetings, training, learning and development sessions as required
  • Respects patient confidentiality by adhering to HIPAA standards.

Knowledge, Skills and Abilities:

  • Ability to multi-task and function in a fast paced environment.
  • Customer service skills - empathetic, active listener, who has strong follow through skills.
  • Proficient computer and data entry skills.
  • Basic knowledge of anatomy and medical terminology preferred.
  • Listen to feedback or constructive criticism from management and apply it to themselves.
  • Critical thinking – the ability to think creatively, problem solve and work independently.
  • Knowledge of ICD-10, CPT codes.
  • Must be comfortable utilizing de-escalation skills when communicating with patients and physician offices in crisis.

Educational Requirements:

  • High school diploma or general education degree (GED)
  • Knowledge and understanding of health insurance carrier eligibility and authorization processes
  • 1-2 years related experience in healthcare office setting, preferably in Radiology
  • EPIC experience a plus

Physical demands/Working Conditions:

Work is performed in a business office environment. Work is primarily stationary, requires sitting or standing for long periods of times; Manual dexterity and eye-hand coordination sufficient to operate a keyboard and other office equipment is required.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The above declarations are not intended to be an all-inclusive list of the duties and responsibilities of the job described, nor are they intended to be such a listing of the skills and abilities required to do the job. Rather, they are intended only to describe the general nature of the job.

Advanced Radiology offers outstanding compensation and benefits plans designed to reward and retain exceptional employees. Our comprehensive benefits package includes:

Medical, Dental and Vision Insurance; Prescription Plan; HSA with matching employer contribution, Company Paid Life Insurance, 401K Plan and Profit Sharing with employer contribution, Paid Holidays, and generous Paid Time Off. You will also receive free company swag, fun wellness challenges with prizes, awards, and recognition programs, and much more

Advanced Radiology Consultants is an Equal Opportunity Employer. Apply today and join our team of dedicated and caring professionals

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