Authorization & Account Verification Specialist I

Authorization & Account Verification Specialist

Join our culture of caring! With every action we take, Advanced Radiology Consultants is committed to building and maintaining the trust of our referring physicians and providing our patients with exceptional care.

Advanced Radiology is one of the largest independent radiology practices in the tri-state area with the most experienced radiologists. We look for team members who want to grow and be professionally challenged, while enjoying a rewarding, caring, and friendly environment. We are looking for an Authorization & Account Verification Specialist to join our team. The pay range for this role will depend on experience and qualifications.

Schedule: Monday - Friday 8:30am to 5:00pm

Position Summary:

An Authorization & Account Verification Specialist reviews radiology orders to verify demographic information, insurance eligibility, review prior-authorization requirements, initiate or verify authorization for requested examination CPT code (when applicable) by insurance, third party liability or other and follow medical policies when applicable. Entering complete and accurate information in the patients account.

Essential Job Duties and Responsibilities:

• Review requested radiology order for patient demographic data, insurance/billing information, requested CPT and clinical information
• Ensure all patient demographic and insurance information is current and accurate:
  1. Utilizing EPIC EMR, referring office and/or patient to verify and update patient demographic data and insurance coverage, real-time eligibility, commercial insurance or third party websites, telephone verification or both to verify patient's coverage and benefits.
• Verify prior authorization requirements for requested CPT by covering carrier
  1. Obtain pre-authorizations on high modality imaging requests
     • Conduct a thorough review of all documentation submitted to support diagnostic imaging procedure; including script review from referring physician, detailed review of EMR and/or clinical information submitted by referring physician and review of patient insurance information.
     • Enters detailed notes regarding communication with insurance carriers and/or health care providers and steps taken in authorization process.
  2. Verify referring office provided prior-authorization by patient, date of birth, referring provider, CPT and rendering company and/or location
• Accurate and timely communication with needed staff on authorization issues.
  1. Communicates regularly with insurance companies, health care providers, internal scheduling department, front desk coordinators and clinical staff at sites; on any exams that require clinical review and/or denials from insurance carriers.
• Responds to telephone, electronic and in person inquires and complaints.
• Thorough review of scheduled CT, MR, NM, PET, Doppler US patients to ensure accurate and timely receipt of demographic, insurance and clinical information required for the patient's examination.
• Maintains positive relations and interactions with insurance companies, referring offices, patients and internal ARC staff.
• Demonstrates initiative in problem solving and resolving customer satisfaction issues.
• Audits their own work to ensure quality and reports safety or quality events
• Attends meetings, training, learning and development sessions as required
• Respects patient confidentiality by adhering to HIPAA standards.

Knowledge, Skills and Abilities:

• Ability to multi-task and function in a fast paced environment.
• Customer service skills - empathetic, active listener, who has strong follow through skills.
• Proficient computer and data entry skills.
• Basic knowledge of anatomy and medical terminology preferred.
• Listen to feedback or constructive criticism from management and apply it to themselves.
• Critical thinking – the ability to think creatively, problem solve and work independently.
• Knowledge of ICD-10, CPT codes.
• Must be comfortable utilizing de-escalation skills when communicating with patients and physician offices in crisis.

Educational Requirements:

• High school diploma or general education degree (GED)
• Knowledge and understanding of health insurance carrier eligibility and authorization processes
• 1-2 years related experience in healthcare office setting, preferably in Radiology
• EPIC experience a plus

Competencies:

• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Responds to requests for service and assistance.
• Interpersonal Skills - Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control.
• Oral Communication - Listens and gets clarification; Responds well to questions.
• Teamwork - Contributes to building a positive team spirit.
• Ethics - Treats people with respect; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
• Organizational Support - Follows policies and procedures.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Monitors own work to ensure quality.
• Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions; Uses equipment and materials properly.
• Adaptability - Adapts to changes in the work environment; Able to deal with frequent change, delays, or unexpected events.
• Attendance/Punctuality - Is consistently at work and on time.

Physical demands/Working Conditions:

Work is performed in a business office environment. Work is primarily stationary, requires sitting or standing for long periods of times; Manual dexterity and eye-hand coordination sufficient to operate a keyboard and other office equipment is required.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed 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.

Work Smart, Live Well: The success of Advanced Radiology is earned every day through our dedication to quality patient care and continual improvement of the patient experience. Our success allows us to enjoy a wide range of benefits designed to support and enhance our lives, both at work and at home.

Health Benefits:

• Medical and Prescription Drug Coverage
• Dental Coverage
• Vision Coverage
• Health Savings Account (HSA) with Matching Employer Contribution

Additional Benefits:

• Generous Paid Time Off (PTO)
• Paid Holidays
• 401(k) Plan with Employer Contribution
• Annual Profit-Sharing Plan Contribution
• Paid Opt-Out Benefit Option
• Basic Life and Accident Insurance

Advanced Radiology is an Equal Opportunity Employer, offering outstanding compensation and benefits plans designed to reward and retain exceptional employees. Apply today and join our team of dedicated and caring professionals!