Prior Authorization and Scheduling Specialist - Interventional Radiology

Description

Neuroscience Group is growing! We have a newly created position on our Prior Authorization and scheduling team that works primarily with Interventional Radiology. This position will work Monday - Friday 8 hours per day. As an integral member of the Patient Access Team, the Interventional Radiology (IR) Scheduling/Authorization Specialist will both schedule and obtain prior authorization for Interventional Radiology procedures performed by Neuroscience Group Interventional Radiologist taking place in partner hospital settings. 

For over thirty years, Neuroscience Group has provided excellent neurologic care for the Fox Valley and Northeast Wisconsin. Ours is the only medical facility in the area that combines neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management and physical therapy. Our practice has grown to over 50 providers and serves patients in nine outlying clinics scattered throughout the region. Our mission is to improve lives by providing the very best in brain, spine and pain care and we do that by living our company core values: compassionate care, teamwork, fiscal responsibility, continuous learning, leadership and community involvement.

RESPONSIBILITIES:

Prior Authorization:

• Upon receiving the anticipated Procedure order from the Provider, 
• Verifies and reviews all patient insurance information as it applies to the pre-certification process,
• Verifies correct CPT and DX codes for the requested procedure(s)
• Determine necessity for pre-authorization,
• Reviews chart documentation to ensure patient meets medical policy guidelines,
• Obtains authorization via payer website, phone or fax form depending on insurance requirements,
• Communicates with the involved parties regarding benefit eligibility and other financial issues.  
• Notifies patients and practitioners of any services requested and/or referred that are not authorized by insurance; schedules Peer to Peer consults for denied authorizations.
• Assists with submission of appeal letters/clinicals if needed.
• Follows up regularly on pending cases.
• Responds to both written and oral correspondence regarding scheduling changes/cancellations in a timely and accurate manner.  

Interventional Radiology Scheduling

• Schedule hospital-based IR procedures for patients with appropriate provider and facility using computerized scheduling programs. 
• Uses Epic chat and Google Doc program to communicate scheduling of procedures
• Informs equipment representatives of upcoming procedure, providing accurate facility location, date and time, and any changes that occur.
• Schedule all preoperative and postoperative appointments regarding the procedure.
• Completes and faxes any required pre op testing orders to appropriate locations if applicable.
• Confirms procedure authorization is valid and informs IR authorization representative if update is necessary.
• Answers incoming calls and schedules/confirms patient procedures, along with any related appointments using proper telephone etiquette.
• Coordinates the related documentation and communication, including adding important details to education letter in Epic to be finished by IR triage team.

Requirements

KNOWLEDGE/SKILLS REQUIRED TO BE SUCCESSFUL IN THIS POSITION

• Previous experience in medical preauthorization/precertification required
• Surgery authorization preferred
• Previous procedure scheduling experience preferred
• Knowledge of health care insurance and third-party payers. (commercial, Medicare/Medicaid, VA, Work Comp, etc.)
• Previous experience with CPT and ICD-10 coding 
• Prior EPIC experience preferred
• Proficient computer knowledge and keyboarding skills (Microsoft Office programs)
• Medical terminology
• Excellent verbal and written communication skills
• Customer service experience
• Strong organizational skills
• Detail-oriented
• Ability to multi-task and remain focused while managing a high-volume, time-sensitive workload
• Critical thinking skills and decisive judgment 

TYPICAL PHYSICAL DEMANDS AND WORKING CONDITIONS

• Primarily seated work but will require some position change including bending, stooping, and stretching. 
• May involve lifting supplies up to 20 to 30 pounds.
• May occasionally need to assist with wheelchair transfers.
• Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment. 
• Requires normal range of hearing and eyesight in order to communicate and function within this setting.

BENEFITS

At Neuroscience Group we offer a very competitive salary. In addition to great pay we also offer the following benefits:

• No nights, no weekends, and no holidays!
• Health Insurance
• Health Savings Accounts with a generous employer contribution
• Dental Insurance
• Vision Insurance
• Company paid Long Term Disability and Life Insurance
• Voluntary Life and Short Term Disability Insurance
• Voluntary Accident and Critical Illness Insurance
• Generous PTO and Sick Banks
• 401(k) with guaranteed employer contribution, Profit Sharing, and a Cash Balance Pension Plan
• Employee Assistance Program
• Timber Rattler tickets
• Holiday party, summer picnic, and annual recognition for years of service
• Annual Employee Appreciation Day