Preauthorization Spec

General Summary:

The Preauthorization Specialist is responsible for obtaining authorizations for procedures performed at the diagnostic centers.  This position will work with internal and external offices to obtain patient information to complete insurance requirements for obtaining pre-authorizations for outpatient procedures. This position will also assist in scheduling, task management and other duties as assigned. 

Main Responsibilities:

• Coordinate and schedule patients’ procedures based on orders and authorization approvals. 

• Interact with patients’, physicians and other staff both within the Diagnostic Centers, outside facilities providing accurate, timely and responsive information

• 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 pre-study regarding their potential choices when authorization is pending or denied, financial obligations

• Ensure efficient telephone communication

• Maintain accurate records of what insurance require authorizations and types of exams that require an 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)

Education/Experience/Knowledge:

• High School diploma or equivalent required

• General understanding of Radiology procedures

• 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

Physical/Mental Demands:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential: 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.

Marginal: 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.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management reserves the right to revise the job or to require that other or different tasks be performed as assigned.

All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities.