Insurance Specialist

RAYUS Radiology•Portland, OR

About The Position

RAYUS Radiology is seeking an Insurance Specialist to provide expertise in insurance pre-certification and authorization of services. The role involves contacting insurance companies and patients to verify insurance information and maintaining positive relationships with referring physicians and patients. This is a full-time position working Monday through Friday, 7:00 a.m. to 3:30 p.m. The Insurance Specialist prioritizes patient outreach before exams, verifies network participation and authorization requirements, documents pre-authorizations, gathers information needed for scheduled exams, and accurately enters information into the computer system. The role also supports price quote processes, secures workers’ compensation approvals, gathers signs and symptoms to support medical necessity, and provides backup for front desk reception and scheduling as needed.

Requirements

High school diploma or equivalent.
One year of healthcare experience working with a variety of health insurance plans for pre-certification and authorization of benefit coverage.
Prior experience with managed care and physician office scheduling.
Experience with Microsoft Office Suite.
Proficiency using computer systems and typing.

Nice To Haves

Bilingual.

Responsibilities

Prioritize workload to contact patients before their exams, giving highest priority to patients with the greatest payment responsibility.
Determine whether a patient's insurance is part of the provider network.
Call insurance companies to obtain pre-certification or authorization.
Receive and document pre-authorization from patients and/or insurance companies.
Contact patients and referring offices, following HIPAA guidelines, when additional insurance information is needed before a scheduled exam.
Enter information accurately into the computer system, including dates schedule requests were received, patient names, referring physicians, and procedures.
Maintain positive interactions with referring offices, patients, and staff.
Provide backup for front desk reception and scheduling as needed.
Complete payor-related information, including payor, payor class, and appointment date.
Obtain workers’ compensation approvals from insurance companies before scheduled exams.
Obtain patient signs and symptoms to support medical necessity.
Complete other duties and projects as assigned.