Primary duties include the verification of financial coverage and pre-authorization of patient appointment for specified Radiology exams. Requires knowledge of a variety of imaging procedures to be able to assist others in the appropriate booking of a wide range of imaging exams. Other duties not mentioned are not excluded from this position if the work is similar, related, or are a logical assignment to the position. Performs in accordance with the facility’s policies and procedures. Follows the facility’s standards for ethical business conduct. Conducts self as a positive role model and team member. Participates in facility committees, meetings, in-services, and activities
Principal Duties and Responsibilities:
- Verifies insurance benefits and obtains prior authorization for patient exams being performed at Hawthorn Medical/SMG.
- Records all insurance benefit and certification information in the applicable computer system. Completes and distributes all paperwork required by insurance and Imaging department.
- Gathers all necessary information from secretaries to obtain pre-authorizations and pre-certifications as stipulated by each individual health plan for Diagnostic Imaging services and communicates with scheduling when additional information is required. .Interfaces on a daily basis with insurance carriers, individual insurance provider authorizers, medical groups, and scheduling coordinators to maximize efficiency.
- Follows company/department policies and procedures as well as compliance standards. Notifies management staff when problems arise.
- When providing scheduling services, maintains communication with the ordering physicians and their secretaries to schedule patients for a variety of imaging procedures.
- Knowledge regarding the appropriate exam preparation, appointment arrival time and contraindications. Able to communicate these instructions to both the scheduling secretaries and the patients that may call directly.
- Utilizes payer websites to determine eligibility and benefit determination to ensure radiology exams are covered and to prevent denials.
- Other duties as assigned.
High school diploma or equivalent required, associate’s degree or Secretarial certificate preferred. Minimum of 2-4 years’ experience in medical office setting required; medical terminology, and computer skills preferred.
Skills and Abilities Required:
Excellent customer service /communication skills.
Detailed knowledge of third party payer requirements for authorization requirements to facilitate payment for Imaging services.
Familiar with medical terminology, ICD-10 coding and CPT procedure codes preferred
Ability to process multiple tasks in an ever-changing environment and prioritize workload effectively. Must be able to function independently.
While performing the duties of this job the employee is frequently required to sit, walk, stand. The employee is occasionally required reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. May be exposed to various patient conditions including infectious diseases, blood, and bodily fluids. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.