Prior Authorization Coord

Brown Medicine•Cranston, RI

20h•Onsite

About The Position

Under supervision of the Manager Diagnostic Imaging Support Services, the Prior Authorization Coordinator is responsible for the integrity of the pre-registration and prior authorization processes for outpatient radiological services within Brown University Health. This role coordinates and arranges for all outpatient radiology orders to ensure patients have received financial clearance from insurance companies and troubleshoots as needed. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence, which guide everyday actions with patients, customers, and one another. Additionally, all employees are expected to demonstrate core Success Factors including Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.

Requirements

High school diploma or equivalent required.
Knowledge of business systems, office procedures, computer skills, medical terminology and health insurance processes/terminology including, but not limited to, CPT and ICD-10 coding.
Strong organizational skills, critical thinking and focus to detail required to manage high volume of radiologic orders requiring prior authorization and/or financial clearance.
Analytical skills to evaluate effectiveness of work flow with the ability to make recommendations, develop and adapt to changes as necessary.
Interpersonal skills necessary to provide effective communication with patients and other healthcare professionals within and outside of Brown University Health.
Two years of previous experience in health care environment with emphasis in health insurance billing and reimbursement, healthcare operations, database management and patient/ provider interaction.

Responsibilities

Registers patients prior to scheduled appointments to obtain updated account information for accurate insurance billing.
Confirms patient eligibility with insurance carriers/third party payors and obtains pre-authorization requirements in accordance with established medical policies.
Coordinates and ensures appropriate insurance authorizations are obtained and/or received in a timely manner.
Reviews, recognizes and understands clinical documentation from patient records pertinent to obtaining prior authorization as necessary.
Analyzes orders, authorizations and records for discrepancies that may affect insurance coverage and/or denial of claims.
Notifies and coordinates with ordering physicians and providers when peer-to-peer discussions are required to obtain prior authorization of services being denied by patients’ insurance.
Professionally communicates with various Brown University Health personnel to resolve billing issues, authorization denials and financial clearance of patient appointments.
Provides mature, quality customer service to patients, their families and/or their representatives.
Ensures all patients are financially cleared by insurance/ third party payor prior to their scheduled appointments.
Performs other duties as assigned.