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Prior Authorization Specialist
Position Summary
Obtains prior authorizations for Breast and Biopsy procedures. Serves as backup for Magnetic Resonance Imaging (MRI) and Cat Scan exams for High Resolution/RAA. Backup scheduling of all radiology imaging studies in the Med Informatics System.
Individual Character Requirements
- All employees are expected, as part of their job requirements, to:
- Work collaboratively with others
- Contributes to the success of their department
- Communicates effectively
- Organized, neat and time efficient
- Accountable and responsible in carrying out their duties
- Follows company policies
- Conducts themselves professionally, with self-control, and
- Contributes to a positive work environment
Reporting
Reports directly to the Scheduling Supervisor
Supervision
None
Typical Physical Demands
Work may require sitting for long periods of time; also stooping, bending and stretching for files and supplies. Will occasionally lift files or paper weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, calculator, telephone, copier and such other office equipment as necessary. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts. It is necessary to view and type on computer screens and to work in an environment which can be very stressful.
Typical Working Conditions
Work is performed in an outpatient radiology office environment. Work may be stressful at times due to high volumes of MRI/CT prior authorizations, high volume of scheduling calls, and handling multiple tasks at once.
Duties and Responsibilities
- Verifies that all order, insurances and authorizations are in place for patient appointments and packet is complete within a 2 hour timeframe
- Places calls to insurance companies and utilizes online portals to verify and update insurance information and authorizations as needed
- Acts as liaison between the clinic and the referring providers
- Notifies appropriate administrative staff of any changes to the schedules and insurance issues.
- Performs duties and responsibilities of Scheduler as needed:
- Answers incoming calls in a prompt and courteous manner as well as makes outbound scheduling calls and assists with Front Desk scheduling
- Obtains patient demographic, insurance information and requested procedure data from various sources to reserve a scheduled appointment time.
- Maintains work area in a neat and orderly manner.
- Performs related work as required and other duties as assigned.
Performance Requirements
- Knowledge of technical office procedures:
- Knowledge of CPT and ICD 10 codes
- Knowledge of all radiology practice modalities (Mammogram/Ultrasound/X-Ray/CT/MRI)
- Proficient in medical terminology.
- Ability to obtain and present concise data in verbal and written forms.
- Knowledge of grammar, spelling, and punctuation to type information.
- Skill in operating a copier, facsimile and other office equipment.
- Ability to use common software packages (e.g., spreadsheets, databases, word processing, statistical, e-mail and internet).
- Ability to prioritize department functions and services.
- Ability to speak clearly and concisely, follow and comprehend oral and written instruction.
- Ability to promote excellent interpersonal skills.
- Ability to establish and maintain effective working relationships with patients, employees, physicians and the public and understand the role of various providers throughout the healthcare community.
Education
- High school graduation or GED.
- Diploma in Medical Insurance Billing & Coding preferred
Experience
- 2 years of prior authorization experience, preferably in a radiology office setting.
- 2 years medical scheduling experience.
- Efficient in Word and Excel.
Certificate/License: None.
Alternative to Minimum Qualifications: None
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