2 years of progressive insurance authorization experience preferred. Epic experience desired.
Thorough knowledge of authorization processes
Basic understanding of insurance policies/procedures
Detail oriented with excellent telephone, analytical, organization and time management skills
Radiology Authorization & Eligibility Specialist at Gbmc
Collaboration with clinical staff regarding challenging patient needs
Basic understanding of complete revenue cycle
Knowledge of ICD-10 and CPT coding practices
Strong computer skills, including EMR knowledge and Microsoft Office
Skill in data analysis and interpretation
Strong interpersonal skills
Ability to work in a fast-paced environment and meet frequent deadlines
Ability and initiative to plan for and complete daily activities with minimal direction
Ability to assist with process and procedure development
Principal Duties and Responsibilities:
Verifies patient's insurance eligibility, benefits, and authorization requirements for specific imaging procedures.
Collaborates with members of all care teams to ensure effective communication regarding all commercial insurance issues.
Facilitates problem-solving with clinical departments, providers, referral sources, insurance companies, and authorization staff.
Accurately obtains insurance authorization for patients
Ensures authorization is provided in a timely manner.
Comprehensively documents insurance discussions in the Epic referral to communicate up to date details with colleagues.
Collaborates with Oncology staff, Pharmacy Team, RN Navigators, and Laboratory services to minimize denials and obtain authorizations in a timely manner. Prioritizes authorization requests according to medical urgency.
Reviews medical records for submission to insurances, abstracting information from patient medical records pertaining to patient treatments, procedures, and guidelines as required.
Reviews patient treatment plan including frequency and dosage prior to treatment and reviews the applicable payer reimbursement
criteria to ensure that the specific payer's medical necessity criteria are met.
Track authorization status and follows up on pending or denied requests. Maintains a 4-day window to ensure unauthorized procedures are removed from the schedule.
Communicates any changes in schedule to patient as well as authorization status and any out-of-pocket expenses to the patient in a timely manner.
Quickly and courteously responds to concerns from patients, staff, and others involved in patient care while maintaining a respectful demeanor.
Conducts outbound calls to patients and providers for patient support. Accepts inbound calls from patients and providers to provide support.
Follows departmental standards to document all calls.
Promptly identifies and resolves all operational issues affecting insurance verification and authorization to ensure a smooth workflow from order creation to billing.
Works closely with nursing staff to ensure that patients are scheduled in a timely manner.
Maintains internal processes to comprehensively track authorization requirements by patient and follows up as appropriate utilizing established Epic work queues.
Assists with appeals and denial management as necessary
Maintains current knowledge of payers' requirements for pre-authorizations, certifications and verifications.
Assists with training new hires in authorizations
May perform other duties as assigned.
All roles must demonstrate GBMC Values
Respect
I will treat everyone with courtesy. I will foster a healing environment.
Treats others with fairness, kindness, and respect for personal dignity and privacy
Listens and responds appropriately to others' needs, feelings, and capabilities
Excellence
I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.
Meets and/or exceeds customer expectations
Actively pursues learning and self-development
Pays attention to detail; follows through
Accountability
I will be professional in the way I act, look and speak. I will take ownership to solve problems.
Sets a positive, professional example for others
Takes ownership of problems and does what is needed to solve them
Appropriately plans and utilizes required resources for various job duties
Reports to work regularly and on time
Teamwork
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Benefits
Vision insurance
Additional Information
Under direct supervision, performs all eligibility, verification and authorization requests required for all Radiology patients. Responsible to obtain ongoing authorizations to secure reimbursement of services. Acts as liaison with insurance companies' utilization review departments to ensure all insurance company policies are met. Works collaboratively with the billing team to ensure coverage for dates of service for all patients. Ensures re-verification of all Radiology patients.
Continuously reviews and remains compliant with ever-changing information from insurance companies. Provides ongoing reporting to management regarding status and challenges encountered. Education:
High School
Gbmc · Gbmc Hospital