What are the responsibilities and job description for the Precertification Specialist position at The Radiology Clinic?
Purpose
The Precertification (Precert) Specialist is responsible for gathering adequate and necessary information from the referring physician offices to obtain precertification before patient scheduling of CT, MRI, or PET scans.
Essential Functions:
- Verify Physician's signatures and research faxed information from referring physicians’ offices for precertification forms.
- Initiate pre-cert process via phone and document.
- Follow up on precepts that are put in review status—ask for any additional information necessary for obtaining precertification.
- Notify the referring physician's office of any denials.
- Update the schedule list daily for CT, MRI, and PET—verify that all patients scheduled have pre-cert authorizations and that the numbers are entered into the RIS system along with the expiration date of authorization and the date of service rendered.
- Obtain precerts for any other insurance with which The Radiology Clinic participates.
- Check CT, MRI, PET, and NUC.MED schedules for prior notifications for United Healthcare and Tricare Insurance prior to the patient's arrival for the test.
- Responsible for updating authorizations with BC/BS when the patient arrives for CT or MRI due to patient history or radiologist protocol.
- Obtain precerts on added patients sent to the Radiology Clinic on an emergency basis while the patient waits.
- Assist referring physician offices when they call for help and answer any questions they may have.
- Maintains current knowledge of insurance companies’ requirements regarding precertification.
- Other duties as assigned.
Knowledge & Skills
- The ideal candidate would be well-rounded and have extensive knowledge and understanding of precertification processes.
- Medical Industry Experience a plus.
- Superior problem-solving skills.
- Excellent communication and telephone skills.
- Experience in, and a strong understanding of, insurance companies rules and regulations as it pertains to precertification.
- Strong project management kills (planning and execution) with demonstrated ability to multi-task and set priorities within tight timelines.
- Detail-oriented with the ability to handle moderately complex assignments under minimal supervision.
- Must be educated on and compliant with HIPAA.
Education
High school diploma or equivalent.
Computer Skills
- Advanced skills in Microsoft Office applications, specifically Word, Excel, and Outlook.
- Knowledge of RIS/PACS computer systems.
- Knowledge of e-mail/scheduling software applications.
Physical Work Demands
- Able to sit and work at a computer keyboard for extended periods of time.
- Able to stoop, kneel, bend at the waist, and reach on a daily basis.
- Able to perform general office administrative activities: copying, filing, delivering and using the telephone.
- Able to lift and move up to 25 pounds occasionally.
Requires normal, correctable vision, speaking and hearing.
Other Work Demands
- Regular and on-time attendance.
- Excellent communication skills
- Strong presentation skills.
- Strong organizational and time management skills.
Job Type: Full-time
Pay: $13.00 - $15.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
Work Location: Hybrid remote in Tuscaloosa, AL 35406
Salary : $13 - $15
