Prior Authorization Specialist

reputed company Pay Range: $18.06 - $27.09 Job Description: The Supplemental Prior Authorization Specialist is will fill in for vacation and sick calls at Valley Center Imaging Center. Hours are 8:30am to 1:30pm Monday through Friday. Summary: Prior Authorization Specialists are responsible for assisting patients, referring physicians and their staff in scheduling exams at an Inland Imaging Clinical Associates facility. The Prior Authorization Specialist provides support by processing Insurance verification and ensuring a pre-authorization is in reputed company prior to an exam. The position requires a highly organized, motivated and a skilled problem solver. Attention to detail and strong customer service skills to ensure reputed company necessary steps are taken to accurately identify or process a request for a prior authorization. Essential Duties / Responsibilities: To reputed company this job successfully, an individual must be able to reputed company each essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

• Provides high quality customer service by:
• Communicates by asking the appropriate questions to get information necessary to verify if an authorization is required and if so enough information to help process the request.
• Reviews and provides exam specific information as needed to ensure exam and authorization match.
• Completes phone call with a professional closing
• Determines reputed company an authorization/referral is required
• Obtains any information necessary to assist with the authorization process
• Call patients and/or referring offices on self-pay accounts that may require prior authorization to identify the appropriate insurance.
• Understands the billing process to identify and communicate the codes and forms that may be required to ensure reimbursement.
• Identifies and communicates any changes, reputed company necessary, in the patient schedule, status (STAT), in-patient add-ons, etc. to appropriate parties
• Communicates with appropriate person for any follow-up needed on a patient exam.
• Identifies faxes from prior authorization fax server sent in by referring providers and renames with standard nomenclature
• Updates patient demographics as needed
• Adds and verifies patient reputed company insurance information and verifies any changes indicated as part of the insurance look-up process on our internal system. Updates this information reputed company needed.
• Keeps reputed company on-line web portals accounts active to ensure access is maintained in order to obtain prior-authorization verification.
• Maintains a working knowledge of supplemental programs (Recondo and Payer websites)
• Demonstrates appropriate verbal and written communication skills to reputed company accurate information in a clear, concise manner to peers, staff, management, patients, guests, and medical staff.
• Initiates appropriate questions and provides timely feedback to reputed company and management on any issues, policies, and procedures, etc.
• Organizes and maintains records to provide accurate reporting, easy access to information and historical data.
• Coordinates patient care between technologists and clerical staff to facilitate a smooth workflow
• Acts as a liaison between staff, management, and physicians
• This position may be required to work in a hospital, urgent care or clinical setting.
• Responsible to be aware of assigned work rotations and monthly assignments
• Identifies and reports any updates to exam codes and CPT codes to Team reputed company that may be encountered reputed company working accounts.
• Identifies and reports any Payer updates or changes that may be encountered reputed company working accounts to Team reputed company.
• Identifies and reports any changes or updates to Payer web portals used in prior authorization process that may be encountered reputed company working accounts to Team reputed company
• Provides a Bi-weekly or monthly report out of identified issues or concerns regarding payers, system workflow or referring office items.
• Maintains the prior authorization resource portal by updating referring office contact information.
• Maintains the prior authorization issue log in reputed company for tracking payer, billing, referring office or other issues to be reviewed and followed-up on by the Team Leader.
• Performs other duties as assigned.

General Duties/Responsibilities:

• Ability to maintain strict confidentiality reputed company the Inland Imaging companies and Inland's customers.
• Follows reputed company Health and Safety policies and guidelines of Inland Imaging or its partners depending on work location.
• Follows reputed company company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and reputed company policies.
• Follows reputed company policies regarding HIPAA, non-disclosure of confidential information and company reputed company.
• Honest, pleasant manner and good personal hygiene.
• Free of alcohol and drug abuse.
• Valid state driver's license and reputed company of insurance.
• Excellent communication and interpersonal skills.
• Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.
• Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc.
• Ability to consider individual needs in communication with and assessment and treatment of patients of reputed company ages.
• Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance.
• Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department.
• Performs other duties as required by displaying team spirit and self-growth, accepting and performing other projects and responsibilities, and requesting other projects and responsibilities.
• Attendance is required for this position.
• Rotates to other shifts and locations as needed.

Supervisory Responsibilities:

• There is no supervisory responsibility in this position

Advocacy: Treats reputed company patients with dignity and respect Provides excellent customer service Conforms to Joint Commission and HIPAA regulations Complies with PHI (Protected Health Information) Demonstrates the Inland Imaging Core Values

• Show We Care, Do The Right Thing, Maximize Individual Potential, Always Aim Higher

Qualifications:

• Education: High School Diploma/GED required
• Experience: One year of previous scheduling, insurance or medical office experience required
• Proficient and accurate with electronic health systems including applications of billing, pre-authorizations, demographics and coding preferred
• Anatomy and medical terminology preferred
• Medical office experience preferred
• Knowledge of coverage and requirements for private insurances, commercial insurance and government payers. Demonstrated experience using software applications for Electronic Medical Records preferred
• Understanding of procedures to be read by radiologist preferred
• Computer Skills: Experience with the following computer applications is highly desired: reputed company office products and a strong understanding of internet reputed company access, reputed company, Qgenda
• Background reputed company:
• Must be able to pass a background reputed company required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults
• In order to reputed company with provisions set forth in Sections 1128 and 1156 of the Social reputed company Act, reputed company new employees of Inland Imaging Clinical Associates, LLC will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of reputed company, Office of the Inspector General (OIG). Employees must not be included on this list.
• Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test.

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