Imaging Resource Specialist I

UnitedHealth Group • Weymouth, MA

56d • $16 - $29 • Hybrid

About The Position

Responsible for obtaining necessary authorizations for Imaging/Radiology exams. Ensures that all necessary documentation and preparatory activities have been completed and that proper authorizations are in the record before and/or after visits have occurred. Utilizes a thorough knowledge base on a range of referral-related issues, keeping current on the policies and procedures of a multitude of current insurance payors. Research referral and provider information as needed. Also responsible for coordinating and facilitating the processing of patients with job related injuries or illnesses. Serves as the contact person for the patient, employer, insurer, utilization review agents, and practice staff members.

Requirements

• High School Diploma/GED
• 1+ years of scheduling experience in a healthcare setting
• 1+ years of healthcare business office experience OR 1+ years of customer service experience in a healthcare setting
• Intermediate level of proficiency with Microsoft Office products, etc
• Strong interpersonal, customer service, time management and organizational skills
• Familiarity with insurance coverage and health care terminology
• Ability to explain referral requirements to both staff and patients
• Ability to work independently as well as to network effectively internally with other department staff
• Ability to work with a high level of detail in a busy and demanding environment
• Ability to utilize electronic communication in a clear, accurate and professional manner (position requires constant electronic communication between staff, leadership and providers)

Nice To Haves

• Experience with electronic medical records (e.g. EPIC)
• Previous experience in a job requiring the ability to multi-task and prioritize activities
• Previous call center experience

Responsibilities

• Answers multi-queue phone lines to schedule and confirm patient appointments
• Schedules imaging appointments, determines appropriate appointment length, and reviews necessary pre-test preparation with patient
• Manages referral work queue (WQ) lists in accordance with standard department authorization and outreach protocols/guidelines.
• Ensures that proper referral statuses are utilized in order to maintain WQs is up to date
• Enters referral information in electronic medical records system (Epic), updating referral information and processing renewals.
• Conducts thorough chart research to eliminate duplicate referral requests and maintain imaging WQ is up to date
• Responsible for managing STAT and urgent requests, outreach and scheduling
• Performs all decision tree questions; documents all patient responses prior to scheduling. Identify cases for high-risk review
• Using Solutions, schedules imaging appointments, determines appropriate appointment length, reviews necessary pre-test preparation with patient, to include imaging specific procedures
• Manages imaging orders received from Non-Atrius Providers by entering orders into the Atrius EPIC system and ensuring that all necessary clinical information is present. Follows up with referring to the provider’s office to obtain missing information when necessary
• Keeps patient and provider informed of status of all referrals (approved, pending or denied)
• Demonstrates a high level of competency when handling difficult phone calls and dealing with complex issues
• Demonstrates attention to detail and ability to problem solve complex cases involving frequent contact with a range of internal and external contacts as well as the need to understand terms and processes of multiple insurance payors
• Researches questions/concerns from patients regarding bills and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process. Refers patients to appropriate staff (e.g., patient account representatives) for billing issues related to insurance benefits and services covered under the benefits plan
• Complete WQ outreaches, notify patients of exam orders (typically via calls and myhealth messages) and ensure that patients are provided the appropriate number and prompt options to call back to schedule their studies
• Trains and orients new staff as needed

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution

What This Job Offers

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