IMAGING PRE-AUTHORIZATION/DENIAL INSURANCE SPECIALIST

Description

Mountain View Hospital is looking for an Imaging Pre-Authorization/Denial Insurance Specialist to join our team!

JOB SUMMARY: Verifies insurance eligibility and obtains pre-authorization for diagnostic tests and procedures. Works closely and communicates with referring providers and imaging schedulers to authorize and process requests timely. Investigates and assists with insurance denials.

BENEFITS:

Taking care of our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

DUTIES AND RESPONSIBILITIES:

1. Answers incoming calls to the facility and requests in a professional, timely manner.
2. Responsible for verifying eligibility and obtaining preauthorization for diagnostic tests and procedures.
3. Works with the referring providers to make sure we receive all the patient demographics, order that meets requirements, and other necessary documentation needed to obtain an authorization.
4. Insures authorizations are done timely and communicates with referring provider office, imaging schedulers and patient when delays or insurance issues arise to ensure continuity of care.
5. Knows and understands the difference between routine and emergent authorization requests and when to use them.
6. Communicates with worker’s compensation and VA Administrations to obtain approval for services.
7. Communicates appropriately and clearly to the patients, referring providers, insurance companies, supervisor, coworkers and providers.
8. Assists with insurance denials and the appeal process. Helpful in researching patient accounts for insurance payment issues.
9. Maintains department records, reports, forms and documents in EMR.
10. Responsible for knowing hospital policies and being familiar with hospital services that are available.

ABOUT MOUNTAIN VIEW:

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.

Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

Qualifications

Education:  High school diploma or general education degree (GED).

Experience:  Must have 1-5 years medical terminology experience. Experience with medical insurance is required.

Equipment/Technology:  Ability to use hospital information system, and operate basic computer functions and software. 

Language/Communication:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Employee must possess the ability to speak effectively, before groups of customers and or employees of the organization. Good telephone skills are a must.

Mathematical Skills:  Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. 

Mental Capabilities: Ability to apply common sense to carry out instructions furnished in written, oral, or diagram form. Employee must posses the ability to deal with problems involving several concrete variables in standardized situations.

Interpersonal:  Ability to work well with others as well and be approachable.