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.
- 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.