Authorization Specialist

12 hours ago

Norwalk, CT, United States Stamford Health Full time
Job Description

This role will be a Monday-Friday shift, 8am-4pm.

MAJOR ACCOUNTABILITIES/CRITICAL RESPONSIBILITIES:
  • Proactive verification and/or authorizations for insurance approval for scheduled and non-scheduled performed radiological exams.
  • Reviews referring physician and patient documentation for Medical Necessity against insurance protocol requirements for pre-certification purposes.
  • Actively communicates with technologists and radiologists throughout the work day regarding status of authorization for scheduled exams (e.g.., communicate need for reschedule and/or cancellation if authorization not in-hand).
  • Actively communicates with technologists and radiologists throughout the work day regarding any changes from scheduled exams to exams to be performed (based on established protocols) and communicating changes to referring providers and patients, as well as ensuring acquisition of accurate authorizations and written orders.
  • Direct liaison to referring provider's offices and patients regarding new, changed, or pending insurance authorizations, as well as on-going education of changes in authorization requirements. Will be located on-site to allow for face-to-face interactions with patients and/or referring providers when necessary.
  • Active participation in development of on-going process improvements related to authorization management processes.
  • Responsible for scheduling stat, emergent patients for outpatient diagnostic exams. Interacts with patients, their
  • representatives, physicians, physician office staff, employers and others to gather and ensure accuracy of
  • demographic, billing and clinical information. Produces and distributes required forms with accurate patient
  • information.
  • Attends scheduled staff meetings, in service education opportunities and participates in continuing education programs. Formulates and maintains effective working relationships with employees and other managers of the health care team.
  • Respects and protects the patient's rights to confidentiality and privacy and discloses information only for the professional purposes which are in the patient's best interests with full consideration of their legal rights. Displays a positive attitude when interacting with provider's office staff, providers and fellow employees.

For the initial phase of implementation of this position, the Radiology Authorization Specialist will focus on the following:

• MRI and CT outpatients, only (proactively verifying authorization on file for these modalities up to 72 hours in advance of scheduled appointment date/time.)

• Active interaction and communication with technologists and radiologists regarding exams scheduled vs. exams performed.

• Management of acquisition of required insurance pre-certification/pre-authorization for same-day/add-on patients.

QUALIFICATIONS/REQUIREMENTS:

• High School Graduate or equivalent.

• Medical and computer background

• Accurate typing skills.

• Displays a positive attitude at all times.

• Effectively communicates with supervisors and management regarding any issues or concerns.

• Demonstrates tact and understanding when dealing with patients and staff.

• Accepts constructive criticism and responds appropriately.

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