High School diploma or equivalency required
2 plus years experience with pre-certifications required
Summary: Provide pre-certification for imaging services. Collect and verify patients insurance coverage, pre-certification requirements of patients insurer, update registration, prepare and complete paperwork in preparation for patients imaging.
RESPONSIBILITIES:
- Efficiently and pleasantly work with referring physician offices; providing pre-certification services for referring physicians offices
- Obtain all relevant patient clinical/demographic data from referring physician office
- Use Pre-Certification template to obtain all necessary clinical information to successfully obtain pre-certification from third party.
- Communicate with all parties including referring physician, Radiology and billing vendor regarding updated status of pre-certs.
- Inform referring physician offices when pre-certifications are denied and work with the office to appeal the denied pre-cert.
- Remain knowledgeable of pre-certification requirements for all insurance plans.
- Assist in maintaining records/protocols as third party rules and guidelines are changed or modified.
- Using web-based third party networks as well as telephone contact, obtain pre-certification for referring physicians.
- Review pre-certifications confirming that all studies are correctly pre-certified.
- Input into scheduling system pre-certification information adding patient financial notes as necessary.
- Schedule appointments for Radiology clinical practice sites
- For add-ons, ensure that all required paperwork is complete; obtain prior reports, images or other documentation as required.
- Communicate directly with technologists, radiologists and front desk to ensure seamless communication related to referring physician office requests.
