Prior Authorization and Scheduling Specialist - Interventional Radiology

Neuroscience Group • Appleton, WI

3h • Onsite

About The Position

Neuroscience Group is expanding its Prior Authorization and scheduling team with a new position focused exclusively on Interventional Radiology. This role involves working 4 days per week, 8 hours per day, with a varying day off based on volume. As a key member of the Patient Access Team, the Interventional Radiology (IR) Scheduling/Authorization Specialist will be responsible for both scheduling and obtaining prior authorization for Interventional Radiology procedures performed by Neuroscience Group Interventional Radiologists in partner hospital settings. Neuroscience Group has been providing neurologic care for over thirty years in the Fox Valley and Northeast Wisconsin, offering a unique combination of neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management, and physical therapy. The practice has grown to over 50 providers, serving patients across nine regional clinics. The company's mission is to improve lives through excellent brain, spine, and pain care, guided by core values including compassionate care, teamwork, fiscal responsibility, continuous learning, leadership, and community involvement.

Requirements

• Previous experience in medical preauthorization/precertification required
• Knowledge of health care insurance and third-party payers. (commercial, Medicare/Medicaid, VA, Work Comp, etc.)
• Previous experience with CPT and ICD-10 coding
• Proficient computer knowledge and keyboarding skills (Microsoft Office programs)
• Medical terminology
• Excellent verbal and written communication skills
• Customer service experience
• Strong organizational skills
• Detail-oriented
• Ability to multi-task and remain focused while managing a high-volume, time-sensitive workload
• Critical thinking skills and decisive judgment

Nice To Haves

• Surgery authorization preferred
• Previous procedure scheduling experience preferred
• Prior EPIC experience preferred

Responsibilities

• Verifies and reviews all patient insurance information as it applies to the pre-certification process
• Verifies correct CPT and DX codes for the requested procedure(s)
• Determine necessity for pre-authorization
• Reviews chart documentation to ensure patient meets medical policy guidelines
• Obtains authorization via payer website, phone or fax form depending on insurance requirements
• Communicates with the involved parties regarding benefit eligibility and other financial issues
• Notifies patients and practitioners of any services requested and/or referred that are not authorized by insurance; schedules Peer to Peer consults for denied authorizations
• Assists with submission of appeal letters/clinicals if needed
• Follows up regularly on pending cases
• Responds to both written and oral correspondence regarding scheduling changes/cancellations in a timely and accurate manner
• Schedule hospital-based IR procedures for patients with appropriate provider and facility using computerized scheduling programs
• Uses Epic chat and Google Doc program to communicate scheduling of procedures
• Informs equipment representatives of upcoming procedure, providing accurate facility location, date and time, and any changes that occur
• Schedule all preoperative and postoperative appointments regarding the procedure
• Completes and faxes any required pre op testing orders to appropriate locations if applicable
• Confirms procedure authorization is valid and informs IR authorization representative if update is necessary
• Answers incoming calls and schedules/confirms patient procedures, along with any related appointments using proper telephone etiquette
• Coordinates the related documentation and communication, including adding important details to education letter in Epic to be finished by IR triage team

Benefits

• No nights, no weekends, and no holidays!
• Health Insurance
• Health Savings Accounts with a generous employer contribution
• Dental Insurance
• Vision Insurance
• Company paid Long Term Disability and Life Insurance
• Voluntary Life and Short Term Disability Insurance
• Voluntary Accident and Critical Illness Insurance
• Generous PTO and Sick Banks
• 401(k) with guaranteed employer contribution, Profit Sharing, and a Cash Balance Pension Plan
• Employee Assistance Program
• Timber Rattler tickets
• Holiday party, summer picnic, and annual recognition for years of service
• Annual Employee Appreciation Day

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 11-50 employees