PRE CERTIFICATION SPECIALIST

Position Summary:

Diagnostic Imaging Centers, P.A. is looking for dedicated and caring professionals to join our team! This is a great opportunity for a career minded individual in healthcare. If you enjoy a fast paced team oriented environment and an excellent staff of co-workers, you have found the right place! The successful applicant will share our "patient" first philosophy. We offer excellent benefits including health insurance, 401k/profit sharing, paid time off, and numerous other benefits.

We are seeking an experienced Pre-Certification Specialist to join our team. The right individual will assure authorization is obtained for all procedures and who will take full ownership of their position. Must possess outstanding organizational skills, ability to stay on task in a fast-pace environment with minimal supervision, and adapt in a constantly changing environment.

Responsibilities:

• Monitor scheduled hi-tech radiology (CT, MRI) procedures and maintain organized list with status of pre-certification process.
• Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information in RIS system as required.
• Check insurance payment policy for scheduled procedures and obtain prior authorization when required.
• Manage electronic documents efficiently and effectively.
• Verify receipt of all necessary pre-authorization documents prior to procedure.
• Communicate effectively with the facility in which the procedure will be performed as needed.
• Assign appropriate ICD10 and CPT coding based on physician orders and documentation.
• Build excellent relationship with our referring providers.
• Notify referring physician for insurance plans that require an authorization.
• Serve as a resource on insurance, retro-authorizations and billing.
• Perform other duties or functions as assigned.
• Ability to communicate in a clear, professional, and timely manner with all staff members as well as with patients and insurance carriers and referring healthcare practitioners.
• Ability to follow through to completion on all assignments.
• Must be able to work independently and as part of a team.
• Excellent time management skills.

• High School Diploma or equivalent

• Junior College/Technical School preferred

• Prior authorization experience for multiple healthcare insurances preferred

• Excellent customer service skills

• Knowledge of medical terminology