Prior Authorization Coord

SUMMARY:

Under supervision of the Manager Diagnostic Imaging Support Services is responsible for the integrity of the pre-registration and prior authorization processes for outpatient radiological services within Brown University Health. Coordinates and arranges for all outpatient radiology orders to ensure patients have received financial clearance from insurance companies and troubleshoot as needed. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done.

The core Success Factors include:

Instill Trust and Value Differences Patient and Community Focus and Collaborate

RESPONSIBILITIES

PRINCIPAL

DUTIES AND RESPONSIBILITIES

Registers patients prior to scheduled appointments to obtain updated account information for accurate insurance billing. Confirms patient eligibility with insurance carriers/third party payors and obtains pre-authorization requirements in accordance with established medical policies.

Coordinates and ensures appropriate insurance authorizations are obtained and/or received in a timely manner.

Reviews, recognizes and understands clinical documentation from patient records pertinent to obtaining prior authorization as necessary. Analyzes orders, authorizations and records for discrepancies that may affect insurance coverage and/or denial of claims.

Notifies and coordinates with ordering physicians and providers when peer-to-peer discussions are required to obtain prior authorization of services being denied by patients' insurance.

Professionally communicates with various Brown University Health personnel to resolve billing issues, authorization denials and financial clearance of patient appointments.

Provides mature, quality customer service to patients, their families and/or their representatives.

Ensures all patients are financially cleared by insurance/ third party payor prior to their scheduled appointments. Performs other duties as assigned.

MINIMUM QUALIFICATIONS

BASIC

KNOWLEDGE

High school diploma or equivalent required. Knowledge of business systems, office procedures, computer skills, medical terminology and health insurance processes/terminology including, but not limited to, CPT and ICD-10 coding.

Strong organizational skills, critical thinking and focus to detail required to manage high volume of radiologic orders requiring prior authorization and/or financial clearance.

Analytical skills to evaluate effectiveness of work flow with the ability to make recommendations, develop and adapt to changes as necessary.

Interpersonal skills necessary to provide effective communication with patients and other healthcare professionals within and outside of Brown University Health.

EXPERIENCE

Two years of previous experience in health care environment with emphasis in health insurance billing and reimbursement, healthcare operations, database management and patient/ provider interaction.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS

Normal office environment; may experience some visual fatigue as result of extended periods of work on the computer.

INDEPENDENT ACTION

Performs independently within the department's policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.

SUPERVISORY RESPONSIBILITY

None.

Pay Range:

$19.03•31.39

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Rhode Island Hospital•593 Eddy Street Providence, Rhode Island 02903

Work Type:

M-F 9:30am•6:00 pm occasional weekends

Work Shift:

Day Daily Hours:

8 hours

Driving Required:

No