Prior Authorization Specialist

Base Pay Range:

Job Description:

The Prior Authorization Specialist is a Full Time, Regular position working Monday-Friday 8:30am - 5pm CST at the Navani Business Center, a wholly owned Inland Imaging company in Arlington, TX.

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, Navani 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 license and proof of insurance.
• Excellent communication and interpersonal skills.
• Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.
• Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc.
• Ability to consider individual needs in communication with and assessment and treatment of patients of all ages.

• Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance.
• Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department.
• Performs other duties as required by displaying team spirit and self-growth, accepting and performing other projects and responsibilities, and requesting other projects and responsibilities.
• Attendance is required for this position.
• Rotates to other shifts and locations as needed.

Supervisory Responsibilities:

• There is no supervisory responsibility in this position

Advocacy:

Treats all patients with dignity and respect Provides excellent customer service Conforms to Joint Commission and HIPAA regulations Complies with PHI (Protected Health Information) Demonstrates the Inland Imaging Core Values

• Show We Care, Do The Right Thing, Maximize Individual Potential, Challenge Convention

Qualifications:  

• Education:  High School Diploma/GED required
• Experience: One year of previous scheduling, insurance or medical office experience required
  • Proficient and accurate with electronic health systems including applications of billing, pre-authorizations, demographics and coding preferred
  • Anatomy and medical terminology preferred
  • Medical office experience preferred
  • Knowledge of coverage and requirements for private insurances, commercial insurance and government payers. Demonstrated experience using software applications for Electronic Medical Records preferred
  • Understanding of procedures to be read by radiologist preferred
• Computer Skills: Experience with the following computer applications is highly desired: Microsoft office products and a strong understanding of internet related access, Workday, Qgenda
• Background Check:
  • Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults
  • In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Navani Health Solutions will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG).  Employees must not be included on this list.  
• Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test including marijuana.

Nuvodia/Inland is an EEO employer...