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Insurance Claims Specialist
2 months ago
RAYUS Radiology is seeking a highly skilled Insurance Specialist to join our team. As a leading provider of radiology services, we are committed to delivering clinical excellence and superior service to our patients and referring providers.
Key ResponsibilitiesInsurance Administration (65%):
- Prioritize workload to ensure all patients are contacted prior to their exam and those with largest responsibility to pay are given highest priority.
- Determine if patient's insurance is a part of the provider network.
- Make outgoing calls to insurance companies for pre-certification or any authorization.
- Receive pre-authorization from patients and/or insurance companies and document.
- Contact patient and referring offices using HIPAA guidelines prior to scheduled exam when additional insurance information is needed.
- Accurately enter a variety of information including date schedule requests received, patient name, referring physician and procedures into computer system.
- Maintain positive interactions with referring offices, patients and staff.
- Back up front desk reception and scheduling area as needed.
Price Quotes (30%):
- Complete payor-related information i.e., payor, payor class, date of appointment.
- Obtain all workers compensation approvals from insurance companies prior to scheduled exam.
- Obtain signs and symptoms in order to support medical necessity.
Additional Responsibilities (5%):
- Complete other duties as assigned.
Required:
- High school diploma or equivalent.
- 1-2 years previous healthcare experience working with a variety of health insurance plans for pre-certification and authorization of benefit coverage.
- Prior experience with managed care and physician office scheduling.
- Microsoft Office Suite Experience.
- Proficient with using computer systems and typing.
Preferred:
- Bilingual.
