Integrated Business Services

Responsibilities

Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, RadNet is Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of RadNet’s success is its people with the commitment to a better healthcare experience. When you join RadNet as our Integrated Business Services Representative, you will be joining a dedicated team of professionals who deliver quality, value, and access in the 21st century and align all stakeholders- patients, providers, payors, and regulators achieve the best clinical outcomes.

Job Summary

The Integrated Business Services Representative will be part of the Managed Care Team with a unique caveat. There is significant alignment with the Reimbursement Operations Leadership and Team. This position will work with leadership in each local market, including the National Payor Database (“NPD”) team, Directors of Contracting, Directors of Insurance Verification Teams (IVT), Directors of Patient Service Representatives (PSRs), Directors of Clinical Operations and Directors of Reimbursement Operations. The position will provide auditing reviews to ensure all necessary policies, procedures, processes and systems are in place to support the maximum and most efficient reimbursement and patient satisfaction. This position has a key role in reimbursement hotline services as it relates to coding and billing questions, obtaining benefits and authorizations and appeals assistance on denied or short paid claims.

You Will

• Takes Reimbursement hotline calls to support local market operations and on demand A/R or benefit design questions.
• Completes benefit and prior authorization questions expediently and accurately to ensure patient satisfaction payer reimbursement.
• Provides exceptional customer satisfaction at all times.
• Internal auditing/assessment functions to ensure compliant processes; preventing denials.
• Consistent documentation of successful corrective actions as a result of auditing processes.
• Provides the most efficient communication to health plans to ensure maximum level of reimbursement.
• Interacts with health plan personnel to educate and influence their decision related to medical management recommendations for approval of reimbursement.
• Industry knowledge and experience to analyze medical claims data to recover incorrect payments.
  
  

If You Are

• Requires a comprehensive understanding Commercial health plans, Medicare and Medicaid health plans.
• Extensive knowledge of radiology medical coding, CPT and HCPCS codes and ICD 10.
• Comprehensive understanding of medical management and health insurance concepts, information management systems and strong analytical and problem-solving skills are required.
• Associates Degree in health care or business related filed required. Exceptions may be made given extensive direct radiology industry related experience of at least 5 years.
  
  

Ideal Candidate Will Possess

• Job characteristics will require a flexible individual with high analytical and clinical interests in radiology.
• Excellent communications and relationship skills are required. Excellent interpersonal and communication skills to deal effectively with all necessary levels within and outside the organization. Problem analysis and problem resolution at both the strategic and tactical level.
• Strong organizational skills and superior attention to detail. Strong decision maker.
• Ability to gain high levels of credibility and excellent persuasion skills to achieve desired results.
• Ability to combine and balance a strong tenacity with excellent diplomacy.
  
  

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