Preauthorization Spec

Holston Medical Group Career•Kingsport, TN

6d•Onsite

About The Position

The Preauthorization Specialist is responsible for obtaining authorizations for procedures performed at the diagnostic centers. This position will work with internal and external offices to obtain patient information to complete insurance requirements for obtaining pre-authorizations for outpatient procedures. This position will also assist in scheduling, task management and other duties as assigned.

Requirements

High School diploma or equivalent required.
General understanding of Radiology procedures.
Must be familiar with Medical terminology. (CPT and ICD-9).
Familiarity with computers and other office equipment.
Must possess excellent communication and organizational skills.
Ability to work in a team environment and collaborate with others.

Nice To Haves

Ability to establish and maintain cooperative working relationships with co-workers and the public.
Ability to interact appropriately with colleagues and patients for different purposes and different context.
Must be able to remain in a stationary position at least 25% of the time.
Medium work that includes moving objects up to 50 pounds occasionally.
Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
Work independently and identify potentially more effective methods of work operations.
Observing an area that can be seen up and down or to right or left while eyes are fixed on a given point.
Ability to identify and distinguish colors.

Responsibilities

Coordinate and schedule patients’ procedures based on orders and authorization approvals.
Interact with patients’, physicians and other staff both within the Diagnostic Centers, outside facilities providing accurate, timely and responsive information.
Verifies patient eligibility and coverage for the procedure using an online application or the telephone; if patient is not eligible on date of service, or procedure is not a covered benefit, explains this to patients.
Obtains precertification/preauthorization from insurance companies prior to diagnostic radiology procedure, using an online application or by contacting insurer on the telephone.
Counsels patients pre-study regarding their potential choices when authorization is pending or denied, financial obligations.
Ensure efficient telephone communication.
Maintain accurate records of what insurance require authorizations and types of exams that require an authorization.
Appropriate documentation of insurance approvals, denials and pending cases.
Multi-tasking/cross training.
Maintain strict confidentiality in all matters relating to personnel and patient PHI (Protected Health Information).