Job description

Under general supervision, facilitates all prior authorization requests submitted by referring physician offices.

PRINCIPAL ACCOUNTABILITIES

1. Receives prior authorization requests from the physician’s office and completes the following processes:

• Reviews the referral for accuracy and ensures all necessary data is included.
• Contacts referring physician’s office if additional information is needed.
• Reviews clinical notes and extracts all pertinent information.
• Inputs and verifies all data and patient demographic information into radiology information system (RIS) and places patient on the call list for exams to be scheduled.

2. Facilitates the receipt of the prior authorization by completing the following processes:

• Contacts the insurance company, either by telephone or via the internet, to determine patient’s eligibility.
• Obtains authorization from the insurance company by providing CPT and ICD-9 codes and clinical information.
• Conducts appropriate follow-up, on a daily basis, on all pending authorizations until final determination has been made.

3. Provides timely communication throughout the prior authorization process by:

• Communicating authorization denials to the referring physician’s office.
• Communicating authorization approval to the referring physician’s office.
• Notifying the Scheduling Department if a scheduled exam is denied.

4. Accurately documents all information and communications, verbal and written, with the patient, provider or insurance company, into the radiology information system (RIS).

5. Answers all incoming calls from referring physicians, coworkers, and patients, in a pleasant and timely manner.

6. Identifies prior authorization-related issues. Communicates appropriately to the PCC Supervisor regarding these and/or other departmental issues.

KNOWLEDGE/SKILLS/ABILITIES

1. Knowledge of CPT and ICD-9 coding, authorization and eligibility practices and paperwork processing requirements

2. Knowledge of medical terminology

3. Knowledge of eligibility software

4. Knowledge of and experience in using office equipment including telephone, fax, computer, adding machine and photocopier

5. Knowledge of and experience in using radiology-related computer systems (RIS)

6. Knowledge of customer service concepts and techniques

7. Ability to process authorization for an average of 30-35 exams per day

8. Ability to understand clinical notes

9. Ability to perform basic mathematical computations

10. Ability to pay close attention to detail for extended periods of time

11. Ability to apply good judgment and problem solving skills

12. Ability to communicate clearly in person and on the telephone

13. Ability to use interpersonal skills to effectively interact with physicians, other facility staff, patients and families when providing instructions, responding to questions or exchanging patient-related information

14. Ability to organize and prioritize tasks effectively

15. Ability to read, understand and follow oral and written instructions

16. Ability to file correctly by alphabetic or numeric system

17. Ability to maintain confidentiality of patient record information

REQUIREMENTS

1. Strong customer service skills and the ability to keyboard proficiently

2. Previous experience in insurance eligibility

3. Previous experience in prior authorization

4. CPT and ICD-9 coding experience

This company is an equal opportunity, affirmative action employer and makes employment decisions without regard to age, race, religion, color, handicap, sex, physical condition, developmental disability, sexual orientation, national origin or any other characteristic protected by federal, state or local law. This policy shall include, but is not limited to, the following: recruitment and employment, promotion, demotion, transfer, compensation, selection for training, layoff and termination.

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