Radiology Pre-Certification Coordinator

4 weeks ago


Bowling Green, Kentucky, United States Graves Gilbert Clinic Full time
Job Summary:

As a Radiology Pre-Certification Coordinator at Graves Gilbert Clinic, you will play a crucial role in ensuring that patients receive timely and accurate medical authorizations. Your primary responsibility will be to review chart documentation, prioritize incoming certification and authorization requests, and obtain authorization via payer websites or by phone. You will also maintain individual payer files, initiate appeals for denied authorizations, and respond to clinic questions regarding payer medical policy guidelines. Additionally, you will confirm the accuracy of CPT and ICD-10 diagnoses in procedure orders, contact patients to discuss authorization status, and process referrals and submit medical records to insurance carriers to expedite prior authorization processes. If you have a strong background in medical pre-certification and prior authorization, excellent communication skills, and the ability to multitask in a fast-paced environment, we encourage you to apply for this exciting opportunity.

Requirements:

* RMA or CCMA highly preferred
* Minimum two (2) years medical pre-certification/prior authorization experience
* Minimum two (2) years experience within a medical/healthcare related field required
* Knowledge of procedure and authorizations and its direct impact on revenue cycle
* Understanding of medical policy guidelines among Payers while utilizing these guidelines to manage authorizations effectively
* Proficient use of CPT and ICD-10 codes
* Excellent computer skills including Excel, Word and Internet use
* Experience with Electronic Medical Record (E.M.R.)
* Detail oriented with above average organizational skills
* Plans and prioritizes to meet deadlines
* Excellent customer service skills (including telephone etiquette); communicates clearly and effectively
* Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

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