Radiology Pre-Certification Specialist

2 weeks ago


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

We are seeking a highly skilled Radiology Pre-Certification Specialist to join our team at Graves Gilbert Clinic. As a key member of our revenue cycle team, you will play a critical role in ensuring seamless patient care and efficient authorization processes.

Key Responsibilities
  • Review patient chart documentation to verify compliance with medical policy guidelines
  • Prioritize and manage incoming certification and authorization requests with urgency
  • Obtain authorization through payer websites or phone calls, and follow up on pending cases
  • Maintain accurate and up-to-date payer files, including requirements for successful authorizations
  • Initiate appeals for denied authorizations and respond to clinic inquiries regarding payer medical policy guidelines
  • Verify accuracy of CPT and ICD-10 diagnoses in procedure orders and contact patients regarding authorization status
  • Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
  • Develop and implement prior authorization workflows, policies, and procedures
  • Ensure accuracy and completeness of information requested and supporting documents
  • Manage correspondence with insurance companies, physicians, and patients as required
Requirements
  • RMA or CCMA certification highly preferred
  • Minimum two years of medical pre-certification/prior authorization experience
  • Minimum two years of experience in a medical/healthcare-related field
  • Knowledge of procedure and authorizations and its impact on revenue cycle
  • Understanding of medical policy guidelines among payers and ability 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
  • Ability to plan and prioritize to meet deadlines
  • Excellent customer service skills, including telephone etiquette


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