Authorization Specialist

PIEDMONT CANCER INSTITUTE PC•Atlanta, GA

23h•$21•Remote

About The Position

The Radiology Authorization Specialist plays a critical role in obtaining pre-certification of Radiology imaging for PCI patients. Radiology Authorization Specialist performs timely and accurate insurance and benefits verification, and pre-certification of Radiology imaging. The successful candidate will be flexible and able to multi-task in a fast-paced, high-volume setting. Previous Hematology/Oncology insurance verification and prior authorization experience is preferred for success in this role. This position is located at our Atlanta office. Position will transition into a fully remote opportunity.

Requirements

High school diploma (or equivalent) is required. Collegiate education preferred.
Hematology/Oncology Authorization experience a plus
Three + years of medical office experience is preferred with demonstrated skills in problem solving, attention to detail, ability to learn and use multiple systems and effective written and verbal communication skills
Advanced technical skills including PC and MS Outlook
Advanced knowledge of health insurance benefits including In-network & out-of-network services
Advanced knowledge of CPT, HCPCs, and ICD-10 codes
Advanced knowledge of medical terminology and business office processes
Strong interpersonal skills
Customer service experience and the ability to prioritize, work accurately, work well independently and able to maintain focus under pressure
Must be able to sit 8 hours/day.
Work may be stressful at times.
Exposed to general indoor working conditions
HIPAA Requirements: Insurance Verification Representative will have access to PHI in the course of his/her duties. The IVR uses PHI for all aspects of billing, patient’s accounts and communications with insurance companies. Applying the minimum necessary standard of HIPAA, the designated record sets to which this employee will have access to: all information in the practice management system, the full medical record, end of day reports from the practice management system, encounter forms, all communications from insurance companies, all collections information.

Nice To Haves

Hematology/Oncology experience strongly preferred, however, not required

Responsibilities

Coordinate with clinic staff to add and update insurance and perform verification and reverification of insurance benefits.
Determination of eligibility, coverage details, and benefits using online resources or phone calls with the insurance company.
Communicates status of verification/authorization process with appropriate team members in a timely and efficient manner.
Ensure verification details for all Radiology Authorization services are documented in the patient’s record.
Verifies completeness and accuracy of all information prior to resolving tasks in the work queue.
Work productively and efficiently from a task-based work queue. Volume may vary, but the Radiology Authorization Specialist is expected to maintain an acceptable level of productivity as determined by the Supervisor to meet business needs.
Acts as liaison between clinical staff, patients, and insurance by informing all parties of coverage issues, and relaying messages pertaining to verification and authorization.
Contacts insurance companies to determine preauthorization requirements for outpatient imaging studies.
Reviews and submits clinical information to support medical necessity of Radiology orders.
Calls insurance companies or uses online tools to obtain preauthorization prior to service date.
Follows-up timely and thoroughly.
Analyzes, investigates, and resolves all authorization denials and peer-to-peer requests.
Researches and assists with denied preauthorization or predeterminations.
File appeals and reconsiderations for denied authorizations.
Utilize reports to initiate preauthorization on Radiology scans and communicate across functional areas to ensure authorization is in place at least 48 hours prior to the scheduled procedure.
Anticipate work needs, organize workflow, follow through with minimal direction, and follow up independently.
Multi-task and use time efficiently, perform professionally at a high level under tight deadlines in a fast paced ever-evolving work environment, successfully prioritize, and adapt to changing demands.
Identify problems or trending issues and provide suggestions for findings and to determine resolutions
Respond timely to emails and telephone messages as appropriate.
Communicate issues to management, including payer, system or escalated account issues.
Regularly meet with Practice Manager to discuss and resolve verification issues or preauthorization obstacles.
Regularly attend weekly/monthly department meetings.
Abide by the Health Insurance Portability and Accountability Act (HIPAA) when handling any and all protected health information (PHI).