Preauthorization Spec

Holston Medical Group Career•Johnson City, TN

2d•Onsite

About The Position

Explore opportunities with Holston Medical Group, part of the Optum family of businesses. Holston Medical Group combines the personal feel of a community-based practice with the strength, resources and career opportunities of a leading national health care organization. As a multispecialty clinic offering care across northeast Tennessee and southwest Virginia, our teams deliver high-quality, value-based care that exceeds expectations while making care easier, more affordable and more accessible. Join us and discover the meaning behind Caring. Connecting. Growing together.

Requirements

High School diploma or equivalent required
General understanding of Radiology procedures for ODC
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
Communication with others to exchange or express information and ideas.
Ability to receive detailed information through oral communication, and to make fine distinctions in sounds.
Determine the accuracy, neatness, thoroughness of the work assigned and perceive general observations.
Remaining upright on the feet, particularly 75% of the time.
Moving about on foot to accomplish tasks.
Bending body downward and forward by bending spine at the waist and/or by bending leg and spine.
Extending the hands and arms in any direction.
Exerting force upon an object so that an object moves away/toward the force.
Picking, pinching, typing or otherwise working, primarily with fingers.
Applying pressure to an object with the fingers and palm.
Perform a variety of duties, often changing from one task to another of a different nature.
Perform with frequent interruptions and/or distractions.
Make appropriate job decisions following standard office policies and past precedents.
Adjust priorities quickly as circumstances dictate.
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.
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’ regarding their potential choices when authorization is pending or denied, financial obligations
Ensure efficient telephone communication
Maintain accurate records of what insurance requires authorization and types of exams and what medication that requires 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)
Need to obtain medication approval through insurance company
Interact with patients, physicians and other staff within the offices to provide accurate, timely and responsive information
Other duties as assigned