MG Insurance Verifier

Summary:

Primary duties include the verification of financial coverage and pre-authorization of patient appointment for specified Radiology exams. Requires knowledge of a variety of imaging procedures to be able to assist others in the appropriate booking of a wide range of imaging exams. Other duties not mentioned are not excluded from this position if the work is similar related or are a logical assignment to the position. Performs in accordance with the facility's policies and procedures. Follows the facility's standards for ethical business conduct. Conducts self as a positive role model and team member. Participates in facility committees meetings in-services and activities

KEY RESPONSIBILITIES:

1. Records all insurance benefit and certification information in the applicable computer system. Completes and distributes all paperwork required by insurance and Imaging department.


2. Gathers all necessary information from secretaries to obtain pre-authorizations and pre-certifications as stipulated by each individual health plan for Diagnostic Imaging services and communicates with scheduling when additional information is required.


3. Interfaces on a daily basis with insurance carriers individual insurance provider authorizers medical groups and scheduling coordinators to maximize efficiency.


4. Follows company/department policies and procedures as well as compliance standards. Notifies management staff when problems arise.


5. When providing scheduling services maintains communication with the ordering physicians and their secretaries to schedule patients for a variety of imaging procedures.


6. Knowledge regarding the appropriate exam preparation appointment arrival time and contraindications. Able to communicate these instructions to both the scheduling secretaries and the patients that may call directly.


7. Utilizes payer websites to determine eligibility and benefit determination to ensure radiology exams are covered and to prevent denials.


8. Other duties as assigned.

REQUIRED QUALIFICATIONS:

• Minimum of 2-4 years' experience in medical office setting required; medical terminology and computer skills preferred.


• Excellent customer service /communication skills.


• Detailed knowledge of third-party payer requirements for authorization requirements to facilitate payment for Imaging services.


• Familiar with medical terminology ICD-10 coding and CPT procedure codes preferred


• Ability to process multiple tasks in an ever-changing environment and prioritize workload effectively.


• Must be able to function independently.

EDUCATION:

• High school diploma or equivalent required associate degree or Secretarial certificate preferred

WORKING CONDITIONS:

While performing the duties of this job the employee is frequently required to sit walk stand. The employee is occasionally required reach with hands and arms; climb or balance; stoop kneel crouch or crawl; and talk or hear. May be exposed to various patient conditions including infectious diseases blood and bodily fluids. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: BHMG-North Dartmouth-535 Faunce Comer Rd USA:MA:North Dartmouth

Work Type: Full Time

Shift: Shift 1

Union: Non-Union