Authorization & Account Verification Specialist

Advanced Radiology Consultants•Shelton, CT

About The Position

An Authorization & Account Verification Specialist reviews radiology orders to verify demographic information, insurance eligibility, review prior-authorization requirements, initiate or verify authorization for requested examination CPT code (when applicable) by insurance, third party liability or other and follow medical policies when applicable. Entering complete and accurate information in the patients account.

Requirements

Ability to multi-task and function in a fast paced environment.
Customer service skills - empathetic, active listener, who has strong follow through skills.
Proficient computer and data entry skills.
Basic knowledge of anatomy and medical terminology preferred.
Listen to feedback or constructive criticism from management and apply it to themselves.
Critical thinking – the ability to think creatively, problem solve and work independently.
Knowledge of ICD-10, CPT codes.
Must be comfortable utilizing de-escalation skills when communicating with patients and physician offices in crisis.
High school diploma or general education degree (GED)
Knowledge and understanding of health insurance carrier eligibility and authorization processes
1-2 years related experience in healthcare office setting, preferably in Radiology

Nice To Haves

EPIC experience a plus

Responsibilities

Review requested radiology order for patient demographic data, insurance/billing information, requested CPT and clinical information
Ensure all patient demographic and insurance information is current and accurate
Utilizing EPIC EMR, referring office and/or patient to verify and update patient demographic data and insurance coverage, real-time eligibility, commercial insurance or third party websites, telephone verification or both to verify patient’s coverage and benefits.
Verify prior authorization requirements for requested CPT by covering carrier
Obtain pre-authorizations on high modality imaging requests
Conduct a thorough review of all documentation submitted to support diagnostic imaging procedure; including script review from referring physician, detailed review of EMR and/or clinical information submitted by referring physician and review of patient insurance information.
Enters detailed notes regarding communication with insurance carriers and/or health care providers and steps taken in authorization process.
Verify referring office provided prior-authorization by patient, date of birth, referring provider, CPT and rendering company and/or location
Accurate and timely communication with needed staff on authorization issues.
Communicates regularly with insurance companies, health care providers, internal scheduling department, front desk coordinators and clinical staff at sites; on any exams that require clinical review and/or denials from insurance carriers.
Responds to telephone, electronic and in person inquires and complaints.
Thorough review of scheduled CT, MR, NM, PET, Doppler US patients to ensure accurate and timely receipt of demographic, insurance and clinical information required for the patient’s examination.
Maintains positive relations and interactions with insurance companies, referring offices, patients and internal ARC staff.
Demonstrates initiative in problem solving and resolving customer satisfaction issues.
Audits their own work to ensure quality and reports safety or quality events
Attends meetings, training, learning and development sessions as required
Respects patient confidentiality by adhering to HIPAA standards.