Precertification Specialist - Remote

POSITION SUMMARY

At Premier Radiology, the Pre-Certification Specialist's core duties are contacting insurance companies and third-party administrators to determine pre-authorization and/or medical necessity requirements for basic and high-tech outpatient radiology exams and procedures. The specialist is responsible for obtaining the pre-authorization before the scheduled services are performed. The representative will act as a liaison between the patients and referring physician offices when needed to obtain additional clinical documentation.

The ideal candidate has direct experience with radiology and/or the pre-authorization process with insurance companies and third-party administrators. Communicating clearly and professionally with payors and patients is necessary, as direct communication with all parties provides a competitive advantage.

POSITION DUTIES AND RESPONSIBILITIES

• The associate must promptly initiate the authorization request to the appropriate insurance company.
• Oversight and Participation in all aspects of radiology prior authorization process.
• Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
• Responsible for all follow-up phone calls to the insurance company or doctor's office for authorization status or to request additional information.
• Gather all necessary clinical information from the referring doctors' offices to complete the prior authorization process.
• Communicating with other staff about patient pre-authorization status
• You are communicating with patients and providers about pre-authorization status before their service date.
• Handling ingoing and outgoing calls
• Process online authorization as needed through payor portals

DESIRED PROFESSIONAL SKILLS AND EXPERIENCE

• High School or Equivalent Preferred
• Knowledge of medical terminology and diagnosis codes associated with radiology patients
• Prior Authorization Experience is preferred
• Dependable – Reliability
• Understand and be open to continued education on insurance guidelines for radiology procedures
• Ability to work in a fast-paced, high-productivity environment
• Excellent Written and Verbal Communication Skills
• Ability to document accurately and concisely
• Strong Phone & Computer Skills
• HIPAA and OSHA knowledge
• Strong organizational skills
• Prior use of RIS software.
• Critical Thinking

Premier Radiology/Radiology Partners is an equal opportunity employer. We believe in creating and celebrating a culture of belonging and are committed to creating an inclusive environment for all teammates.

Job Type: Full-time

Pay: $18.00 - $20.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Application Question(s):

• Do you have experience working remotely?

Experience:

• Diagnostic Radiology Prior Auth: 3 years (Required)

Location:

• Nashville, TN (Required)

Work Location: Remote

Salary : $18 - $20