Insurance Specialist - Radiology

Christie Clinic's department of Radiology is seeking a full-time Insurance Specialist, Monday-Friday, 7am-5pm at the Main Clinic. Duties include submission and documentation in Epic of prior authorizations for all required radiology exams in accordance with established rules and procedures. Determines if specific services are a covered benefit and documents information in Epic. Previous healthcare experience, experience with health insurance systems, imaging authorizations, and experience in a clinical setting is preferred.
Responsibilities:

• Review and analyze information prior to submission of prior authorizations for insurance carries and governmental payers.
• Accurately obtain the necessary information to process and submit prior authorization requests.
• Accurately determine and document if specific radiology services are covered benefits.
• Proficiently utilize third party payer portals, insurance payer portals, or governmental payer portals to process submission of prior authorization requests; has a detailed knowledge of insurance payers, their portals, and the expectations for prior authorization approvals.
• Utilize phone calls for prior authorization submission only when unable to perform on portals.
• Accurately update insurance information, authorization status, and any other pertinent information before sending all radiology exams to be scheduled.
• Coordinate scheduling of add on/stat radiology exams, to include, prior authorization, technologist communication, scheduling with patient, communication with ordering office, and other communication within the radiology department.
• Coordinate initial denial rationale and follow up with ordering provider/office.
• Correspondence concerning authorization status updates with appropriate personnel (for example, schedulers, ordering offices, etc.)
• Correspondence concerning claim/charge denials with appropriate personnel (for example, radiology coordinator, radiology manager, and/or business services).
• Advocate for patients/providers by processing referrals in a time sensitive manner.
• Identify challenges, trends and/or patterns and work with radiology leadership to address or resolve.
• Meets/succeeds prior authorization productivity goals as outlined by radiology leadership.
• Provide insurance guidance to team members throughout organization.
• Attend Christie Clinic sponsored classes for changes relating to insurance.
• Cross-trained in radiology scheduling as deemed necessary for optimal radiology function.

• Perform related work as required.

Job Type: Full-time