MRI Referral and Authorization Specialist

Essential Functions

• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations (referrals, precertification) before patient arrival for all ambulatory visits, procedures, injections, and radiology services.
• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
• Creates appropriate referrals to attach to pending visits.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.
• Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.
• Fax referral form to providers that do not require any records to be sent.
• Process 75-80 referrals daily.
• For primary specialty office visits, fax referral/authorization form to PCPs and insurance companies in a timely fashion.
• Reviews and notifies front office staff of outstanding patient balances.
• Maintain satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
• Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination, or follow-up status.
• Identifies and communicates trends and/or potential issues to the management team.
• Index referrals to patient account for existing patients.
• Create new patient accounts for non-established patients to index referrals.

Qualifications

• High school diploma/GED or equivalent working knowledge preferred.
• Minimum one year of experience in a healthcare environment in a referral, front desk, or billing role.
• Minimum one year of Athena experience preferred.
• MRI authorization experience is a plus.
• Minimum one year of experience in medical insurance authorizations required.

Benefits

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan with company match
• Employee Assistance Program that is available 24/7 to provide support
• Paid Time Off
• Paid Holidays
• No evenings or weekends
• Business hours Monday - Friday 8a - 5p