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SalaryJob Summary:
The Prior Authorization role is responsible for ensuring all scheduled examinations are authorized for the correct facility, CPT code and that diagnosis is considered payable under the carrier’s regulations. A top candidate has knowledge of commonly-used concepts, practices, and procedures within healthcare/radiology. This role relies on instructions and pre-established guidelines to perform the functions of the job. You will work under immediate remote supervision.
Pay and Benefits:
New employees to this role can expect to be offered $18.48 - $21.99 per hour based on relevant experience, skills, and abilities.
Benefits + Perks:
Prioritize your work / life balance - No on-call or overnight shifts!
Medical, dental and vision benefits
Available HSA and FSA options
Mental health and wellness benefits through our Employee Assistance Program (EAP)
Basic life insurance, and long term disability coverage
Robust 401K package - automatic 3% employer contribution + up to additional 3% employer match
17 days of PTO for all eligible new employees
9 paid holidays
Annual, automatic compensation growth path
Profit sharing
Options for Pet Insurance, Legal / ID Protection, and more
Location: This is a fully remote role Open to Residents ofTexas. TRA will provide all training and equipment.
Schedule: Monday – Friday 9AM – 5:30PM (Pacific Time)
About TRA Medical Imaging
TRA Medical Imaging is a premier, physician-owned and physician-led radiology practice with a 100+ year history of serving the communities of the South Puget Sound region. TRA takes pride in diversity and inclusion, a philosophy that aligns well with our Pacific Northwest values.
We are led by a progressive group of approximately 100 sub-specialized radiologists who take pride in delivering high-quality, patient-centered care while fostering a practice culture intended to feel more like a family than a corporation.
Why Choose TRA Medical Imaging
TRA is an independent, stable, and diversified practice with a broad clinical and geographic footprint. Our governance structure is transparent, democratic and equitable with an unwavering commitment to physician leadership and autonomy. As part of that promise, TRA welcomes employee participation and collaboration and is committed to providing personalized professional development opportunities.
Our commitment to culture is evidenced by our certification as a great workplace by the independent analysts at Great Place to Work and embodied by our mission statement: Trust our family to care for yours. TRA has been the respected provider of excellence in medical imaging in the South Sound since 1918. Join our team as we write the next 100 years of the TRA story.
Want to learn more about TRA’s commitment to patients, employees and our community? Visit https://www.tranow.com/about/careers/ and explore your future with us today!
Essential Job Functions:
Assists referring physician offices in obtaining Prior Authorizations for appropriate procedures.
Verifies all studies requiring Prior Authorization for current eligibility and authorizations prior to scheduled appointments.
Assists and educates patients in Prior Authorization requirements of their insurance carrier.
Reschedules patients to allow for authorization process to complete.
Remains current on all insurance carriers, CPT, ICD-10 and Prior Authorization requirements.
Develops and maintains positive relationships with referring physicians and patients.
Works closely with technologists, front desk, and scheduling staff to make sure exam and authorizations are accurate.
Obtains appropriate patient insurance and demographic information.
Follows all Compliance and insurance requirements for restricted procedures and ensures appropriate clinical information is available or waiver is available for signature.
Researches authorization requirements for restricted procedures and ensures appropriate authorizations are in place.
Enters authorization numbers into the computer system as they are received.
Keeps current on procedures performed.
Appropriate procedures have Prior Authorization (within the individual’s scope of responsibility). For example, if the patient’s appointment is for a knee but an authorization is for an arm, pre-authorization would be responsible for verifying the procedure scheduled was authorized.
Detailed and accurate notes.
Compliance and insurance requirements are matched and waiver notices completed accurately.
Accurate instructions are provided to the referring physician’s office and/or patient.
All work is completed within established goals and accuracy standards.
Maintain confidentiality of all center and patient information at all times, as required by facility policy and HIPAA guidelines
Follow the center exposure controls plan for blood borne and airborne pathogens
Duties include managing multiple phone lines, practicing superior customer service in a teamwork environment, and communicating professionally with other medical facilities.
Ensure the correct insurance information is entered and the correct profile chosen prior to pre-certifying the appointment in the RIS.
Ensure the correct CPT code is scheduled based on the referral.
Utilize the online websites of insurance companies and other electronic tools as an efficient way of verifying eligibility, benefits, and authorization.
Contact the referring physician’s office and/or insurance carriers to obtain the authorization required for billing exams that include, but are not limited to, MRI, CT, NM, PET, FL, and IR.
Ensure the authorization is received in a timely manner and make sure examinations are scheduled appropriately in relation to specific criteria based on medical necessity as required by the insurance carrier’s specific rules.
Obtain the authorization for PET scan by contacting the referring physician’s office for all the pertinent information to be faxed. Enter prior studies on digital data so outside films may be requested. Review all medical records and ascertain the correct CPT, HCPC codes and ICD-9 codes. Contact the insurance carrier to verify patient’s eligibility and benefits. If the insurance carrier requires an authorization, fax all requested documentation to the insurance carrier’s medical review department. When authorization is received, call the patient to schedule the PET exam, providing the patient with all the necessary preparation instructions.
Responsible for ensuring eligibility of all exams performed by verifying coverage through the insurance carrier.
Duties include making notes in patient’s account and scanning information into the RIS.
Follow HIPAA privacy and security policies and procedures.
Provide price quote when requested by the patient, will set up payment arrangements, and review the financial aid process with patient.
Check work email frequently.
Perform all other related duties as assigned.
Qualifications:
Education/Work Experience
High School diploma or GED required.
A formal medical terminology class or equivalent medical office experience is required.
At least 3 years of Medical Office insurance authorization experience required.
Job Knowledge/Skills
Ability to demonstrate effective customer service skills.
Requires effective oral and written skills.
Ability to manage multiple tasks and carry out instructions effectively.
Possess a general knowledge of radiology procedures including: Mammography, CT, Bone Densitometry, Ultrasound, MRI, Nuclear Medicine, PET, Fluoroscopy, IR, and X-ray.
Must perform routine office administration procedures including typing, sorting, and reviewing referrals, faxing and keeping workstation area clean and organized.
Ability to maneuver in insurance websites to verify insurance coverage and claim status.
Knowledge of insurance carriers, insurance web sites and authorization processes.
Knowledge of CPT and ICD-10 codes.
Basic knowledge of radiology procedures.
Communicate professionally with other medical facilities, patients, and customers.
Physical Requirements
Work is classified as sedentary in physical requirements. Requires the ability to lift/carry 1-5 pounds frequently, occasionally 10 pounds maximum.
Mental Requirements
Work requires high attention to detail and the ability to handle mentally stressful situations. The ability to maintain high level of sensitivity towards confidential information is also required.
Working/Environmental Conditions
Normal office or administrative working conditions.
