Prior Authorization Coord

Summary:

Under supervision of the Manager Diagnostic Imaging Support
Services is responsible for the integrity of the pre-registration and prior
authorization processes for outpatient radiological services within
Brown University Health. Coordinates and arranges for
all outpatient radiology orders to ensure patients have received financial
clearance from insurance companies and troubleshoot as needed.

Responsibilities:

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Registers patients prior to scheduled appointments to obtain
updated account information for accurate insurance billing.

Confirms patient eligibility with insurance carriers/third
party payors and obtains pre-authorization requirements in accordance with
established medical policies.

Coordinates and ensures appropriate insurance authorizations
are obtained and/or received in a timely manner.

Reviews recognizes and understands clinical documentation
from patient records pertinent to obtaining prior authorization as necessary.

Analyzes orders authorizations and records for
discrepancies that may affect insurance coverage and/or denial of claims.

Notifies and coordinates with ordering physicians and
providers when peer-to-peer discussions are required to obtain prior
authorization of services being denied by patients* insurance.

Professionally communicates with various Brown University Health personnel
to resolve billing issues authorization denials and financial clearance of
patient appointments.

Provides mature quality customer service to patients their
families and/or their representatives.

Ensures all patients are financially cleared by insurance/
third party payor prior to their scheduled appointments.

Performs other duties as assigned.

Other information:

BASIC KNOWLEDGE:

High school diploma or equivalent required. Knowledge of
business systems office procedures computer skills medical terminology and
health insurance processes/terminology including but not limited to CPT and
ICD-10 coding.

Strong organizational skills critical thinking and focus to
detail required to manage high volume of radiologic orders requiring prior
authorization and/or financial clearance.

Analytical skills to evaluate effectiveness of work flow
with the ability to make recommendations develop and adapt to changes as
necessary.

Interpersonal skills necessary to provide effective
communication with patients and other healthcare professionals within and
outside of Brown University Health.

EXPERIENCE:

Two years of previous experience in health care environment
with emphasis in health insurance billing and reimbursement healthcare
operations database management and patient/ provider interaction.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

Normal office environment; may experience some visual
fatigue as result of extended periods of work on the computer.

INDEPENDENT ACTION:

Performs independently within the department*s policies and
practices. Refers specific complex
problems to the supervisor when clarification of the departmental policies and
procedures are required.

SUPERVISORY RESPONSIBILITY:

None.

Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: Rhode Island Hospital USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union