Pre-Authorization Specialist

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This is a Full-Time position in Stevensville, MD

*insurance and prior authorization experience a plus*

HOURS: Mon- Fri 8 hours a day between 8 am and 5 pm

POSITION SUMMARY

The Preauthorization position is responsible for obtaining information on patient's eligibility status with insurance companies to ensure proper coverage and payment for services—while providing exceptional customer service.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Essential functions are those tasks, duties, and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. They are the major functions for which the person in the job is held accountable. The essential functions include, but are not limited to the following:

  • Supports a collaborative team environment. Creates strong working relationships with insurance groups, patients, referring physicians, Regional Managers, billing department, and imaging center staff.
  • Pre-authorization process:
    • Real-time work list, workload prioritization to obtaining patient authorization prior to the scheduled exam date and time.
    • Verification of patient insurance eligibility.
    • Determining individual insurance plan radiology benefits for scheduled exams.
    • Obtain clinical history from referring physician in order to obtain authorization on a scheduled exam.
    • Provide information from insurance companies and/or review agencies to appropriate staff in an orderly and timely manner.
    • All eligibility, authorization, and determination of benefits information obtained are to be documented appropriately in the patient’s medical record in the RIS.
    • Communicate with patients and/or referring physicians on non-covered benefits or exam coverage issues.
    • Utilizes website solutions and all available resources to obtain information on patient's eligibility status with insurance companies.
    • Works with patients and referring offices to obtain complete and correct insurance information, discuss eligibility results, and discuss alternative payment methods.
    • Properly analyzes various payer eligibility responses to find the information needed to complete the verification.
    • Communicates any updates and/or changes in payer authorization requirements.
    • Follows all HIPPA, compliance, privacy and confidentiality standards.
    • Communicates clearly and effectively in a courteous and professional manner.
    • Provides thorough and accurate information to all callers.
    • Consistent communications to Clerical Team Manager on progress and potential problem cases to receive direction on how to resolve situations.
    • Understand insurance guidelines including Medicare, Private, government and managed care plans.
    • Works with the Clerical Team Manager to establish better efficiencies and process improvement
    • Supports and cooperates with other imaging center staff and outside billing company regarding pre-authorizations and insurance eligibility
    • Performs other related duties as assigned or requested.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

  • Meets time and attendance requirements for the position and uses work hours productively and appropriately. This is a high attendance position.
  • Must be able to work independently with minimal supervision.
  • General computer and Internet knowledge.
  • Accurate data entry skills.
  • Provide clear verbal and written communication.
  • Ability to multi-task and be organized.

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.

While performing the duties of this job the employee is regularly required to talk and hear. The employee frequently is required to stand, walk, sit, use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stoop. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

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