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:

Remote-Massachusetts - N/A Boston, Massachusetts 02108

Work Type:

M-F 9:30am -6:00pm occassional weekends

Work Shift:

Day

Daily Hours: 

8 hours

Driving Required:

No