Authorization Specialist
2 weeks ago
**_SUMMARY:_**
Under the general supervision of the PFS Supervisor, this position is responsible for obtaining prior authorizations, verifying insurance and the collection of selected accounts for Rhode Island Medical Imaging. This position also assists patients with questions regarding coverage and payment issues. The position is a key component of the cash flow for the institution.
**_ PRINCIPAL DUTIES AND RESPONSIBILITIES:_**
- Obtains prior authorizations for selected exams from insurance companies and notes system accordingly.
- Obtains insurance verification and out of pocket expenses for patients prior to his/her exam.
- Communicates out of pocket expenses to the patient and notes accounts accordingly.
- Works daily eligibility reports for hospital sites to verify insurance information.
- Assists patients with questions regarding their benefits and out of pocket expenses in an efficient and professional manner.
- Effectively utilize the billing and scheduling software to ensure efficient workflow.
- Understands the elements associated with completing the HCFA 1500 billing form for payor(s). Understands and resources billing guidelines for each payor and keeps abreast of related changes.
- Utilizes CPT codes, HCPC codes and ICD-10 codes in daily workflow. Uses department and payor resources to ensure accounts are accurate and complete.
- Takes initiative relative to duties, pointing out possible issues or concerns to the Supervisor, Manager and/or Executive Director.
- Enlists the help of the Supervisor on an as needed basis to ensure accounts remain collectable.
- Keeps current with insurance changes regarding policy and coverage guidelines.
- Participates in meetings on an as requested basis/Performs other duties as assigned.
- Ensures all patient interactions are in compliance with HIPAA and federal compliance regulations.
- Maintains a professional manner at all times and adheres to all company policy and procedures.
**_BASIC KNOWLEDGE:_**
- Ability to maintain sensitivity to the nuances of collecting money for medical services, at the same time effective at getting payment for said services.
- Ability to adapt, in a timely manner, to changes in collection rules as defined by State and/or Federal law and/or Management.
- Ability to work in a team environment, including cross training and filling in for other team members when directed by the Supervisor, Manager and/or Director.
- Excellent telephone and interpersonal skills are essential.
- Must be a decision maker, able to handle and prioritize workload and work as a team member.
- Consistently applies the corporate values of respect, honesty, fairness and constant pursuit of excellence in improving the health status for the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a diagnostic imaging company.
**_EDUCATION:_**
- High school graduate or equivalent.
- Post high school courses in insurance billing, computer basics and medical terminology preferred.
- Bi-lingual a plus.
**_EXPERIENCE:_**
One year of Prior Authorization experience preferred. Must have knowledge of third-party billing requirements.
**_ PHYSICAL DEMANDS:_**
To perform this job successfully an individual must be able to perform each essential duty satisfactorily. This description is not intended to be a complete statement of the position, but rather to act as a guide to the general work to be performed. The requirements 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 individual's competencies and customer requirements impact the actual role performed. Prolonged periods of repetitive sitting and standing at a desk and working on a computer. Must be able to perform all essential duties without restriction.
**Join an award-winning organization With 16 private, state-of-the-art medical diagnostic imaging facilities, join the team that has been providing Rhode Island with imaging excellence for over 80 years The American College of Radiology has named RIMI one of the first outpatient diagnostic imaging Centers of Excellence in the country and the first in Rhode Island. RIMI also has the honor of being named a 7-time winner of the Healthiest Employer of RI by Providence Business News, most recently for 2023.**
**RIMI offers best-in-class benefits to eligible employees including multi-tiered health plans, flexible spending accounts, generous paid time off, 401(k) plan with profit sharing component, uniform reimbursement, company "swag", yearly reimbursement for continuing medical education, educational assistance (reimbursement) program, and career development opportunities. Enjoy competitive pay and all in our innovative culture that consistently provides the highest levels of quality, safety, technology, and patient care.
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