Imaging Resource Specialist II

UnitedHealth Group•Norwood, MA

8d•$18 - $32•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. Schedule: FT, 40 hours. Monday – Friday, 9:30am – 6pm Location: Training is 100% onsite for approximately the first 60 days. Once training is completed, will have options to work a hybrid schedule or fully remote (if hybrid, schedule will be confirmed by manager). When working / training onsite, will either be at 1177 Boston Providence Hwy Norwood, MA or 420 Libbey Parkway Weymouth, MA If you reside near Norwood, MA, you’ll enjoy the flexibility of a hybrid-remote position as you take on some tough challenges.

Requirements

High School Diploma/GED
1+ years of healthcare experience including working with various health insurance plans and CPT and ICD coding OR 1+ years of health care 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
Excellent research capabilities on the internet need to determine insurance benefits and find provider information
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)
Experience with third party billing and collections
Exposure to workers’ compensation cases and procedures
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), assigning or obtaining authorization numbers, updating referral information and processing renewals. May manage audit and tracking reports
Contacts appropriate parties to obtain referral authorizations and verify coverage (e.g. the Authorization Services Unit (ASU), National Imaging Associates (NIA) or individual insurance companies). Certain departments may also need to contact additional outside agencies for approval (e.g. American Imaging Management or Med Solutions)
Researches clinician encounter notes and past visit notes to determine if exams may be work or MVA related injuries, and obtain proper authorization from such payors when necessary
Conducts thorough chart research to eliminate duplicate referral requests and maintain imaging WQ is up to date
Responsible for managing STAT and urgent request prior authorizations, outreach and scheduling; documents appropriate updates in referral if authorization is pending or patient cannot be reached
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 CT/MRI specific procedures
Contacts the worker’s compensation insurer to notify of testing, obtain information required to process the claim, and obtain pre-certification for treatment and referral, where required
Faxes requests and other inquiries relating to referrals and communicates with the physicians and clinicians to acquire authorization or to inform them of patient issues or clinical paperwork needed
Manages imaging orders received from Non-Atrius Providers by entering orders into the Atrius EPIC system and ensuring that all necessary prior authorization information is present. Follows up with referring to the provider’s office to obtain missing information when necessary
Verifies that insurance information is accurate and up-to-date and contacts central registration to update insurance information as necessary
Keeps patient and provider informed of status of all referrals (approved, pending or denied)
Identifies issues regarding registration and referral information, processes billing, coding and other information required for billing insurance companies and patients
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
Acts as a resource on referral related issues. Ensures that clinicians have necessary information on benefit plan guidelines, preferred provider/vendor lists and other items needed to make informed referral decisions
May complete WQ outreaches, notify patients of exam approvals (typically via 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