Prior Authorization Specialist

Base Pay Range: $18.06 - $27.09 Job Description: The Supplemental Prior Authorization Specialist is will fill in for vacation and sick calls at Valley Center Imaging Center. Hours are 8:30am to 1:30pm Monday through Friday. Summary: Prior Authorization Specialists are responsible for assisting patients, referring physicians and their staff in scheduling exams at an Inland Imaging Clinical Associates facility. The Prior Authorization Specialist provides support by processing Insurance verification and ensuring a pre-authorization is in place prior to an exam. The position requires a highly organized, motivated and a skilled problem solver. Attention to detail and strong customer service skills to ensure all necessary steps are taken to accurately identify or process a request for a prior authorization. Essential Duties / Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Provides high quality customer service by:
• Communicates by asking the appropriate questions to get information necessary to verify if an authorization is required and if so enough information to help process the request.
• Reviews and provides exam specific information as needed to ensure exam and authorization match.
• Completes phone call with a professional closing
• Determines when an authorization/referral is required
• Obtains any information necessary to assist with the authorization process
• Call patients and/or referring offices on self-pay accounts that may require prior authorization to identify the appropriate insurance.
• Understands the billing process to identify and communicate the codes and forms that may be required to ensure reimbursement.
• Identifies and communicates any changes, when necessary, in the patient schedule, status (STAT), in-patient add-ons, etc. to appropriate parties
• Communicates with appropriate person for any follow-up needed on a patient exam.
• Identifies faxes from prior authorization fax server sent in by referring providers and renames with standard nomenclature
• Updates patient demographics as needed
• Adds and verifies patient current insurance information and verifies any changes indicated as part of the insurance look-up process on our internal system. Updates this information when needed.
• Keeps all on-line web portals accounts active to ensure access is maintained in order to obtain prior-authorization verification.
• Maintains a working knowledge of supplemental programs (Recondo and Payer websites)
• Demonstrates appropriate verbal and written communication skills to relay accurate information in a clear, concise manner to peers, staff, management, patients, guests, and medical staff.
• Initiates appropriate questions and provides timely feedback to lead and management on any issues, policies, and procedures, etc.
• Organizes and maintains records to provide accurate reporting, easy access to information and historical data.
• Coordinates patient care between technologists and clerical staff to facilitate a smooth workflow
• Acts as a liaison between staff, management, and physicians
• This position may be required to work in a hospital, urgent care or clinical setting.
• Responsible to be aware of assigned work rotations and monthly assignments
• Identifies and reports any updates to exam codes and CPT codes to Team Lead that may be encountered when working accounts.
• Identifies and reports any Payer updates or changes that may be encountered when working accounts to Team Lead.
• Identifies and reports any changes or updates to Payer web portals used in prior authorization process that may be encountered when working accounts to Team Lead
• Provides a Bi-weekly or monthly report out of identified issues or concerns regarding payers, system workflow or referring office items.
• Maintains the prior authorization resource portal by updating referring office contact information.
• Maintains the prior authorization issue log in smartsheet for tracking payer, billing, referring office or other issues to be reviewed and followed-up on by the Team Leader.
• Performs other duties as assigned.

General Duties/Responsibilities:

• Ability to maintain strict confidentiality within the Inland Imaging companies and Inland's customers.
• Follows all Health and Safety policies and guidelines of Inland Imaging or its partners depending on work location.
• Follows all company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and related policies.
• Follows all policies regarding HIPAA, non-disclosure of confidential information and company security.
• Honest, pleasant manner and good personal hygiene.
• Free of alcohol and drug abuse.
• Valid state driver's lice

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