Radiology Pre-Certification Specialist

Job Overview

The Pre-Certification Specialist is responsible for the electronic submission of referral and pre-certification/prior authorization of patient accounts for multiple medical specialties.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Contacts insurance companies and other third-party payers to determine pre-authorization requirements for basic and moderately complex outpatient hospital services.
• Calls insurance companies or uses online tools to obtain pre-authorization and/or referral prior to service date. Follows-up timely and thoroughly.
• Ensures all pre-authorization issues are communicated in a timely manner
• Liaisons with physicians staff to obtain additional insurance and/or clinical information.
• Confirms eligibility coverage and benefits with insurance companies. Determines financial responsibility for service.
• Reviews patient charts for clinical justifying medical necessity for the service.
• Follows up properly on all denials and peer-to peer-requests.
• Researches and assist with denied pre-authorization or pre-determinations.
• Documents appropriately regarding all actions authorization referral details and referral medications for specialty care and testing for patients with insurance plans requiring formal referral documentation.

Qualifications:

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• Formidable knowledge of copays deductibles co-insurance for In-network & out-of-network medical benefits
• Able to prioritize work accurately work well independently and able to maintain focus under pressure.
• Working knowledge of medical terminology insurance packages/plans and proficiency with EMR.
• Strong knowledge of government payers. Claim status follow-up is a plus
• Clearly communicate with providers insurance companies staff and patients.
• Excellent verbal and written communication skills.
• Excellent organizational skills Multi-tasking capabilities and detail orientated.
• Customer Service skills with heavy phone contact and client interface.
• Basic computer/PC and internet skills
• Working with MS office products/Excel and Word
• Attention to detail and problem-solving skills
• Must be a great team player and passionate about working.

EDUCATION AND EXPERIENCE:

• High school diploma or equivalent; Bachelors degree preferred
• 2 years of experience in Radiology Pre-Authorization specifically MRIs CT PET and NM required
• 2 years in healthcare registration collections billing pre-certifications (surgery procedures preferred) and customer service
• Previous experience working with medical collections or major hospital systems such as Epic Star Sorrian etc preferred

KNOWLEDGE SKILLS & ABILITIES:

• Strong organization and communication skills
• Ability to use professional language and grammar
• Understanding and fully complying with all federal and state laws and regulations (including HIPAA and FDCPA) with regard to FDCPA state and local laws collection policies and procedures
• Intermediate to advanced Microsoft skills in Word and Excel
• Strong multi-tasking skills and the ability to handle a high call volume in a fast paced environment
• Strong telephone communication and negotiation abilities
• Must have the ability to simultaneously talk and type
• Ability to type minimum of 25 wpm

PHYSICAL SKILLS AND ABILITIES:

While performing the duties of this job the employee is occasionally required to stand or walk and lift and/or move up to 25 pounds. Also may be required to use hands to finger handle or feel objects tools or controls; reach with hands and arms; climb stairs; balance; stoop kneel or crouch or crawl; see talk and hear.

WORK ENVIRONMENT:

Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Incumbent/employee works in a temperature-controlled office environment. Incumbent/employee must be able to work on a computer for the scheduled shift; answers and makes telephone calls using a standard or computer soft telephone; types on a standard keyboard; reads and comprehends information from a computer terminal and/or written resources and utilizes multiple screens and systems simultaneously. All incumbents/employees are provided a Webcam and are required to on camera 100% of the time during the scheduled shift.

Illinois and Maryland residents click below for compensation and benefits:

Cobb is an Equal Opportunity Employer