Insurance Specialist - Radiology

Christie Clinic's department of Radiology is seeking a full-time Insurance Specialist with availability from Monday-Friday 7:00am-5:00pm at the University Clinic, with no night or weekend requirements. 

Duties include submission and documentation in Epic of prior authorizations for all required radiology exams in accordance with established rules and procedures. Determines if specific services are a covered benefit and documents information in Epic. 

Previous healthcare experience, experience with health insurance systems, imaging authorizations, and experience in a clinical setting is preferred.

JOB DUTIES: (This list may not include all of the duties assigned.)

• Review and analyze information prior to submission of prior authorizations for insurance carries and governmental payers.

• Accurately obtain the necessary information to process and submit prior authorization requests.

• Accurately determine and document if specific radiology services are covered benefits.

• Proficiently utilize third party payer portals, insurance payer portals, or governmental payer portals to process submission of prior authorization requests; has a detailed knowledge of insurance payers, their portals, and the expectations for prior authorization approvals.

• Utilize phone calls for prior authorization submission only when unable to perform on portals.

• Accurately update insurance information, authorization status, and any other pertinent information before sending all radiology exams to be scheduled.

• Coordinate scheduling of add on/stat radiology exams, to include, prior authorization, technologist communication, scheduling with patient, communication with ordering office, and other communication within the radiology department.

• Coordinate initial denial rationale and follow up with ordering provider/office.

• Correspondence concerning authorization status updates with appropriate personnel (for example, schedulers, ordering offices, etc.)

• Correspondence concerning claim/charge denials with appropriate personnel (for example, radiology coordinator, radiology manager, and/or business services).

• Advocate for patients/providers by processing referrals in a time sensitive manner.

• Identify challenges, trends and/or patterns and work with radiology leadership to address or resolve.

• Meets/succeeds prior authorization productivity goals as outlined by radiology leadership.

• Provide insurance guidance to team members throughout organization.

• Attend Christie Clinic sponsored classes for changes relating to insurance.

• Cross-trained in radiology scheduling as deemed necessary for optimal radiology function.

• Perform related work as required.

REQUIRED QUALIFICATIONS:

• High School Diploma or equivalent; Associates degree or higher preferred

PREFERRED QUALIFICATIONS:

• Previous health care experience

• Prior experience with health insurance system

• Prior experience with imaging authorizations

• Prior experience within a clinical department setting

TYPICAL PHYSICAL DEMANDS:

Demands include sitting for prolonged periods of time.  Hearing within, or correctable to, normal range, vision correctable to 20/20 and manual dexterity for the operation of office equipment is required.          

TYPICAL WORKING CONDITIONS:

Work is performed in a clinical setting and involves contact with insurance carriers, radiology personnel, and various clinical team members.  Requirements may include working irregular hours.

PAY AND BENEFITS:

The estimated pay range for this position is exclusive of fringe benefits and potential bonuses. Final offers are based on various factors, including skill set, experience, qualifications, and other job-related criteria. 

We also offer a substantial benefits package, including: