pre-certification coordinator radiology - Bowling Green, United States - Graves Gilbert Clinic

Description

Review chart documentation to ensure patient meets medical policy guidelines
Prioritize incoming certification and authorization requests according to urgency
Obtain authorization via payer website or by phone and follow up regularly on pending cases
Maintain individual Payer files to include up to date requirements needed to successfully obtain authorizations
Initiate appeals for denied authorizations
Respond to clinic questions regarding payer medical policy guidelines
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Contact patients to discuss authorization status
Process referrals and submit medical records to insurance carriers to expedite prior authorizations processes
Receive requests for pre-certifications/authorizations and ensure that they are properly and closely monitored
Develop and implement prior authorization work flow, policies and procedures
Review accuracy and completeness of information requested and ensure that all supporting documents are present
Manage correspondence with insurance companies, physicians and patients as required
Other duties as assigned


Requirements:

RMA or CCMA highly preferred
Minimum two (2) years medical pre-certification/prior authorization experience
Minimum two (2) years experience within a medical/healthcare related field required
Knowledge of procedure and authorizations and its direct impact on revenue cycle
Understanding of medical policy guidelines among Payers while utilizing these guidelines to manage authorizations effectively
Proficient use of CPT and ICD-10 codes
Excellent computer skills including Excel, Word and Internet use
Experience with Electronic Medical Record (E.M.R.)
Detail oriented with above average organizational skills
Plans and prioritizes to meet deadlines
Excellent customer service skills (including telephone etiquette); communicates clearly and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload