Derry Imaging Pre- Authorization Specialist
Job Description
Job Description
Join a great team!
Derry Imaging is seeking an experienced Pre-Authorization Specialist who will promote a culture of excellence in patient service. This is a full-time position located in Windham, NH. This is NOT a remote position.
The Pre-Authorization Specialist’s core duties consist of contacting insurance companies and other third-party administrators to determine pre-authorization and/or medical necessity requirements for basic and high-tech outpatient radiology exams and procedures. The successful candidate liaisons with patients, physicians and physician office staff as needed to obtain clinical documentation.
Key Responsibilities Include:
- Validating insurance eligibility and communicating with patients and provider offices to ensure accurate insurance information has been obtained for the radiology services ordered
- Contacting insurance companies and third-party administrators to determine prior authorization necessity and follows proper procedures to secure valid authorization and approval for ordered procedures in a timely and efficient manner
- Communicating with radiology scheduling department as needed
- Validating all authorizations for ordered radiology tests and appropriately documenting these approvals in the patients’ electronic record
- Reviewing any radiology claim denials for lack of authorizations to determine the root cause and appeal any inappropriate denials in a timely manner
- Working closely and collaboratively with providers, clinical staff, and managers
Additional Requirements:
- Provide excellent customer service to Derry Imaging’s patients, family and/or caregivers, as well as all employees and associates
- Maintain the confidentiality of patients’ personal medical and financial information at all times
- Actively engage in all training and education activities related to role
- Perform job duties in a manner that reflects the highest ethical and professional standards
- Ensure and protect the confidentiality of sensitive information by following HIPAA Guidelines
- Comply with all federal, state, and local standards and laws regulating the provision of professional services
- Independently manage workload for pre-authorization review of submitted radiology orders to ensure that the necessary pre-authorization is obtained accurately and swiftly so that patients can be scheduled for their radiology procedures as quickly as possible
- Treat all employees, visitors, and patients with respect and compassion
Education and Experience:
- High school diploma/GED is required
- A minimum of two years’ experience performing Prior authorization for medical services is required
Full Time Positions at Derry Imaging Offer:
- Paid time off
- Competitive pay
- Comprehensive health, dental, prescription, and vision benefits
- Company-paid short-term disability, long term disability and life insurance coverages
- 401k
Derry Imaging Center is American College of Radiology (ACR) accredited in Mammography, Ultrasound, MRI and CT Imaging, and has onsite fellowship-trained radiologists. Offices are located in Bedford, Concord, Derry, Dover, Londonderry, Raymond, and Windham. For more information, please visit www.DerryImaging.com.
We are an equal opportunity employer embracing the strength that diversity brings to the workplace. We provide a welcoming and supportive environment for employees of all ethnic backgrounds, cultures, ages, lifestyles and physical abilities.
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