Radiology Insurance Specialist

Description

JOB SUMMARY

Under the direction of the Imaging Specialist Coordinator and Practice Manager, the Imaging Specialist is a multi-skilled individual responsible for performing PSR/front-office personnel duties; scheduling advanced imaging services via received orders; follow-up on pending orders to ensure patients are scheduled appropriately and timely per established ACR and MCC Imaging protocols; obtaining preauthorization for advanced imaging procedures; verifying patient insurance coverage and benefits; calculating patient out of pocket costs for services and coordinating payments with patients prior to services; charge processing through various methods to facilitate the billing process; insurance follow-up specific to coding denials; responding to questions from patients, Practice Managers, and ordering provider offices; and performing other related duties as requested by Coordinator and Practice Manager.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Identify yourself to internal and external customers by always wearing your identification badge.
• Greet patients with courtesy and respect. Answer questions and direct requests appropriately and efficiently.
• Schedule patient CT’s, MRI’s, and X-rays within the established protocols.
• Check-in patients, obtain pertinent demographic and screening information, copy and scan insurance cards as applicable, provide new patient forms, etc. Follow directed protocols for checking in and screening patients for advanced imaging services.
• Verify and update demographics and insurance in the practice management system at each patient encounter.
• Collect all co-payments, deductibles and other monies owed at the time of service. Follow established protocol for receipt writing, cash collections, and nightly deposits.
• Complete deposit log at the end of each day.
• Provide estimated patient financial responsibility, relative to specialty, to either the patient or patient representative (i.e. patient’s attorney.).
• Verify patient appointment via telephone minimum of 2 days prior to patient appointment, to include pertinent prep information and out of pocket financial expectations.
• Answer telephones promptly and in a professional manner according to MCC customer service standards. Expectation to answer calls within 30 seconds.
• Review all charge tickets and resolve any incomplete items.
• Properly tag and route charge tickets for MedPro.
• Maintain a check and balance system by comparing prepped charts to daily schedules to capture any STAT and/or add-ons.
• Manage schedule to ensure maximum utilization of available time slots. Follow scheduling protocol established and provided by Imaging Tech Supervisor, Practice Manager, and Radiologist(s).
• Comply with MCC policies as directed, carrier policies, and other protocols associated with the medical practice.
• Prepare all pertinent information for scheduled appointments (lab results, medication, stimulator info), according to protocol.
• Retrieves moneybag each morning.
• Accurately key and release charges into the charge scrubbing system as instructed.
• Notify clinical staff the patient has arrived, walk patient to changing area, and provide tech with appropriate documentation and information for the visit.
• Utilizes the Managed Care Worklist to track receipt, delays and completion of requests, to prioritize requests and to obtain authorizations timely before the scheduled date of service, if possible. Imaging Specialists provide all Imaging authorization services and captures authorizations based on when the service is scheduled and according to carrier guidelines and timing of carrier responses. Communicate authorization statuses with patients and the ordering provider. Communicate with the ordering provider as soon as possible if/when carriers require a peer review and/or deny the service authorization.
• Works Eligibility and Authorization denial reports for the Diagnostic Center. Communicates coverage and medical necessity concerns with the Imaging Practice Manager and ordering provider immediately.
• Updates/maintains the Preauthorization Insurance Matrix at minimum on a 6-month basis as carrier guidelines may change.
• Stays current on insurance carrier requirements for pre-authorizations through continuing education opportunities and research.
• Analyzes data recorded in the Managed Care Work list to provide recommendations for process improvements.
• Uploads Diagnostic Center Interpretation report files into electronic medical record daily.
• Updates Diagnostic Center patient accounts with the correct insurance information.
• Independently assesses carrier trends, on a proactive basis and communicates information to appropriate personnel.
• Facilitates communication among parties impacted by coding related matters to produce a timely and satisfactory solution.
• Works Context, Eligibility and Authorization, and Denial reports daily.
• Assists medical offices with questions.
• Responds to questions from patients, or medical department staff related to insurance or account A/R activity in a courteous and professional manner.
• Completes assigned reports and/or projects within deadlines and any other applicable duties as assigned.

CORPORATE CULTURE RESPONSIBILITIES

• Follows established corporate and department-specific policies and procedures.
• Attends all corporate and department-specific required training.
• Upholds MCC’s Purpose, Values, and Vision.
• Abides by MCC’s Corporate Culture Responsibilities.
• Performs other duties as may be assigned cheerfully and willingly.

Requirements

EDUCATION/EXPERIENCE REQUIREMENTS

• Minimum education requirement is high school diploma, or equivalent.
• Coding and/or health insurance certification preferred and highly beneficial, but not required.
• Minimum of 2 years’ experience in healthcare insurance and/or Radiology required.

KNOWLEDGE, SKILLS AND ABILITIES

• Knowledgeable of current insurance carrier requirements regarding pre-authorization of services
• Ability to prioritize and manage multiple tasks.
• Accurately follows written and verbal instructions.
• Displays customer services skills, strong interpersonal skills, close attention to detail, excellent verbal and written communication skills, and basic math skills. Good organizational skills and ability to adapt to frequent changes.
• Be a person of integrity and character, willing to embrace change and make a positive impact in the lives of patients and co-workers.
• Ability to work with staff members at all levels of the organization in a cooperative, team-oriented manner.
• Displays computer proficiency (i.e. PC Windows, MS Office) and ability to quickly learn new applications.
• Proficient in use of English language both in written and verbal communication.
• Communicates in a professional manner with staff in medical offices and co-workers.
• Maintains a positive & cooperative working relationship with internal and external customers.
• Must be able to communicate with individuals of varying socio-economic backgrounds.
• Good understanding of complete charge cycle, including charge entry, all aspects of insurance billing and collections and the self-pay process.
• Must be committed to the protection of confidential information, records and/or reports.
• Possess strong critical thinking and analytical skills.
• Proficient in use of the following computer / software applications: Allscripts, various carrier web-based portals, Practice Partner, Microsoft Excel and Word.

PHYSICAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally)
• Standing/Walking: Occasionally; activity exists up to 1/3 of the time
• Keyboarding/Dexterity: Frequently; activity exists from ¾ of the time
• Ability to look at a computer screen for extended periods.
• Ability to perform constant repetitive hands and finger motions.
• Ability to maintain focus while working in close proximity to others.
• Talking (Must be able to effectively communicate verbally): Yes
• Seeing: Yes
• Hearing: Yes

EMOTIONAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Must exhibit stable work behaviors daily.
• Must possess adequate individual coping skills.
• Ability to remain calm and professional regardless of workload or time constraints.
• Must be able to work under stress and remain calm and professional.

WORK ENVIRONMENT

• Office environment
• Exposed to frequent and constant interruptions in daily functions/schedule.
• May be required to work extended hours to meet department needs.