Desert Radiologists Prior Authorization Coordinator in Las Vegas, Nevada
Prior Authorization Coordinator
2020 Palomino Lane, Las Vegas, NV 89106, 2020 Palomino Lane Suite 100, Las Vegas, Nevada, United States of AmericaReq #994
Tuesday, September 15, 2020
Under general supervision, facilitates all prior authorization requests submitted by referring physician offices.
- Receives prior authorization requests from the physician’s office and completes the following processes:
Reviews the referral for accuracy and ensures all necessary data is included.
Contacts referring physician’s office if additional information is needed.
Reviews clinical notes and extracts all pertinent information.
Inputs and verifies all data and patient demographic information into radiology information system (RIS) and places patient on the call list for exams to be scheduled.
- Facilitates the receipt of the prior authorization by completing the following processes:
Contacts the insurance company, either by telephone or via the internet, to determine patient’s eligibility.
Obtains authorization from the insurance company by providing CPT and ICD-9 codes and clinical information.
Conducts appropriate follow-up, on a daily basis, on all pending authorizations until final determination has been made.
- Provides timely communication throughout the prior authorization process by:
Communicating authorization denials to the referring physician’s office.
Communicating authorization approval to the referring physician’s office.
Notifying the Scheduling Department if a scheduled exam is denied.
Accurately documents all information and communications, verbal and written, with the patient, provider or insurance company, into the radiology information system (RIS).
Answers all incoming calls from referring physicians, coworkers, and patients, in a pleasant and timely manner.
Identifies prior authorization-related issues. Communicates appropriately to the PCC Supervisor regarding these and/or other departmental issues.
Knowledge of CPT and ICD-9 coding, authorization and eligibility practices and paperwork processing requirements
Knowledge of medical terminology
Knowledge of eligibility software
Knowledge of and experience in using office equipment including telephone, fax, computer, adding machine and photocopier
Knowledge of and experience in using radiology-related computer systems (RIS)
Knowledge of customer service concepts and techniques
Ability to process authorization for an average of 30-35 exams per day
Ability to understand clinical notes
Ability to perform basic mathematical computations
Ability to pay close attention to detail for extended periods of time
Ability to apply good judgment and problem solving skills
Ability to communicate clearly in person and on the telephone
Ability to use interpersonal skills to effectively interact with physicians, other facility staff, patients and families when providing instructions, responding to questions or exchanging patient-related information
Ability to organize and prioritize tasks effectively
Ability to read, understand and follow oral and written instructions
Ability to file correctly by alphabetic or numeric system
Ability to maintain confidentiality of patient record information
Strong customer service skills and the ability to keyboard proficiently
Previous experience in insurance eligibility
Previous experience in prior authorization
CPT and ICD-9 coding experience
This company is an equal opportunity, affirmative action employer and makes employment decisions without regard to age, race, religion, color, handicap, sex, physical condition, developmental disability, sexual orientation, national origin or any other characteristic protected by federal, state or local law.This policy shall include, but is not limited to, the following: recruitment and employment, promotion, demotion, transfer, compensation, selection for training, layoff and termination.
Job Family5B Support Staff – Pt Svcs, PCC, Support Svcs
2020 Palomino Lane, Las Vegas, NV 89106, 2020 Palomino Lane Suite 100, Las Vegas, Nevada, United States of America