IMAGING PRE-AUTHORIZATION/DENIAL INSURANCE SPECIALIST

MOUNTAIN VIEW HOSPITAL LLC • Idaho Falls, ID

3d • Onsite

About The Position

Mountain View Hospital is looking for an Imaging Pre-Authorization/Denial Insurance Specialist to join our team! This role is responsible for verifying insurance eligibility and obtaining pre-authorization for diagnostic tests and procedures. The specialist will work closely with referring providers and imaging schedulers to authorize and process requests in a timely manner, and will also investigate and assist with insurance denials.

Requirements

• High school diploma or general education degree (GED).
• Must have 1-5 years medical terminology experience.
• Experience with medical insurance is required.
• Ability to use hospital information system, and operate basic computer functions and software.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to speak effectively, before groups of customers and or employees of the organization.
• Good telephone skills are a must.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to apply common sense to carry out instructions furnished in written, oral, or diagram form.
• Employee must possess the ability to deal with problems involving several concrete variables in standardized situations.
• Ability to work well with others as well and be approachable.

Responsibilities

• Answers incoming calls to the facility and requests in a professional, timely manner.
• Responsible for verifying eligibility and obtaining preauthorization for diagnostic tests and procedures.
• Works with the referring providers to make sure we receive all the patient demographics, order that meets requirements, and other necessary documentation needed to obtain an authorization.
• Insures authorizations are done timely and communicates with referring provider office, imaging schedulers and patient when delays or insurance issues arise to ensure continuity of care.
• Knows and understands the difference between routine and emergent authorization requests and when to use them.
• Communicates with worker’s compensation and VA Administrations to obtain approval for services.
• Communicates appropriately and clearly to the patients, referring providers, insurance companies, supervisor, coworkers and providers.
• Assists with insurance denials and the appeal process.
• Helpful in researching patient accounts for insurance payment issues.
• Maintains department records, reports, forms and documents in EMR.
• Responsible for knowing hospital policies and being familiar with hospital services that are available.

Benefits

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED