Authorization Specialist- Full Time

This position is in Warwick, RI. Monday- Friday 9:30 AM- 6:00 PM.

Under the general supervision of the PFS Supervisor, this position is responsible for obtaining prior authorizations, verifying insurance and the collection of selected accounts for Rhode Island Medical Imaging. This position also assists patients with questions regarding coverage and payment issues. The position is a key component of the cash flow for the institution.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Consistently applies the corporate values of respect, honesty, fairness and constant pursuit of excellence in improving the health status for the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a diagnostic imaging company.

Ensures that all interactions are in compliance with HIPAA, federal and compliance regulations.

Is sensitive to the nuances of collecting money for medical services, at the same time effective at getting payment for said services.

Understands the elements associated with completing the HCFA 1500 billing form for payor(s). Understands and resources billing guidelines for each payor and keeps abreast of related changes.

Is familiar with CPT codes, HCPC codes and ICD-10 codes. Uses department and payor resources to ensure accounts are accurate and complete.

Can effectively utilize the billing and scheduling software to ensure efficient work flow.

Obtains prior authorizations for selected exams from insurance companies and notes system accordingly.

Obtains insurance verification and out of pocket expenses for patients prior to his/her exam.

Communicates out of pocket expenses to the patient and notes accounts accordingly.

Assists patients with questions regarding their benefits and out of pocket expenses.

Works daily eligibility reports for hospital sites to verify insurance information.

Takes initiative relative to duties, pointing out possible issues or concerns to the Supervisor, Manager and/or Executive Director.

Ability to adapt, in a timely manner, to changes in collection rules as defined by State and/or Federal law and/or Management.

Ensures all interactions are in compliance with HIPAA and federal compliance regulations.

Ability to work in a team environment, including cross training and filling in for other team members when directed by the Supervisor, Manager and/or Director.

Enlists the help of the Supervisor on an as needed basis to ensure accounts remain collectable.

Keeps current with insurance changes regarding policy and coverage guidelines.

Assists patients with questions regarding their benefits and out of pocket expenses in an efficient and professional manner.

Maintains a professional manner at all times, and adheres to all company policy and procedures

Participates in meetings on an as requested basis/Performs other duties as assigned.

BASIC KNOWLEDGE:

Ability to operate modern office machinery; to enter and retrieve information via the PC. Must have knowledge of third party billing requirements. Excellent telephone and interpersonal skills are essential. Must be a decision maker, able to handle and prioritize work load and work as a team member.

EDUCATION:

High school graduate or equivalent. Post high school courses in insurance billing, computer basics and medical terminology preferred. Bi-lingual a plus.

EXPERIENCE:

One year of Prior Authorization experience preferred. Willing to train the right candidate.

About Rhode Island Medical Imaging:

Rhode Island Medical Imaging (RIMI) has a network of 12 private state-of-the-art medical diagnostic imaging facilities that are staffed by over 70 board certified radiologists with broad-based experience and subspecialty training in Bone Densitometry (DEXA), Computed Tomography (CT), Magnetic Resonance Imaging (MRI) including the most extensive 3T MRI imaging network in Rhode Island, Mammography, Ultrasound, and X-ray.

RIMI radiologists perform and interpret imaging in Rhode Island at Hasbro Children’s Hospital, Miriam Hospital, Our Lady of Fatima Hospital, Rhode Island Hospital, Roger Williams Medical Center, and Women & Infants Hospital, and most recently at Sturdy Memorial Hospital in Attleboro, MA. Most of RIMI’s radiologists are also faculty members at the Warren Alpert Medical School at Brown University.

For over 75 years RIMI has provided Rhode Island with imaging excellence (since 1943).

*** Benefits offered include medical, dental, vision, life and disability insurance; AFLAC; paid vacation, sick and holidays; 401K and retirement plan.

To Apply

Please submit resumes to Jennifer Voyer at employment@rimirad.com.