Brandywine Urology ยท 3 weeks ago
Prior Authorization Imaging Specialist
Wilmington, DE
Full-time
Onsite
Mid Level
$20/hr - $23/hr
3+ years expBrandywine Urology is a healthcare provider specializing in urology services, and they are seeking a Prior Authorization Imaging Specialist. This role is responsible for managing surgical prior authorization processes, ensuring accuracy in charge entry, and maximizing patient satisfaction and profitability through effective customer service and follow-up on claims.
ConsultingHealth CareHospital
Responsibilities
Input all charges related to the assigned physician's professional services into the practice management system including office and hospital charges in accordance with practice protocol with an emphasis on accuracy to ensure timely reimbursement and maximum patient satisfaction. All charge batches should balance in both number of procedures and total dollar prior to posting
Post all payments, by line-item, received for physician's professional services into the practice management system including co-payments, insurance payments, and patient payments in accordance with practice protocol with an emphasis on accuracy to ensure maximum patient satisfaction and profitability. All payment batches must be balanced in both their dollar value of payments and adjustments prior to posting
Post all credit and debit adjustments to patient accounts with strict adherence to the guidelines in the Procedure Manual
File all charge, payment and adjustment batches in the appropriate format by batch date for quick reference
Review the physician's coding at charge entry to ensure compliance with Medicare guidelines and to ensure accurate and timely reimbursement
Provide customer service both on the telephone and in the office for all patients and authorized representatives regarding patient accounts in accordance with practice protocol. Patient calls regarding accounts receivable should be returned within 2 business days to ensure maximum patient satisfaction
Verify all demographic and insurance information in patient registration of the practice management system at the time of charge entry to ensure accuracy, provide feedback to other front office staff members and to ensure timely reimbursement
Follow-up on all outstanding insurance claims at 30,45,60 days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability
Follow-up on all outstanding patient account balances at 35,60,90,120 days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability using the A/R aged reports
Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to physicians and managers
Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction
Submit primary and secondary insurance claims electronically each day and on HCFA semi-weekly to ensure timely reimbursement
Attendance at relevant seminars to remain abreast of current issues regarding obstetric and/or gynecology accounts receivable, Medicare Compliance and HIPAA
Recommend accounts for outside collection when internal collection efforts fail in accordance with practice protocol
Process refunds to insurance companies and patients in accordance with practice protocol
Reconcile the incoming lockbox deposits in accordance with practice protocol as required to ensure timely payment posting
Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates
Proficiency with all facets of the medical practice management system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry
Maintain information regarding coding, insurance carriers, managed care networks and credentialing in an organized easy to reference format
Maintain an organized, efficient and professional work environment
Adhere to all practice policies related to OSHA, HIPAA and Medicare Compliance
Other duties as assigned
Qualification
Required
Requires a minimum of 3 years of accounts receivable experience, preferably in a surgical subspeciality private practice setting
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
Ability to write routine reports and correspondence
Ability to speak effectively before groups of customers, employees, and/or physicians
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
To perform this job successfully, an individual should have knowledge of and experience on a computer in a Windows environment
Experience with but not limited to spreadsheet software, word processing software and electronic medical record systems is necessary
Ability to handle patients in a pleasant, efficient and professional manner
Preferred
Helpful to have knowledge of medical processes, procedures, lab and radiology tests and medications
Suggested background in medical terminology and general office procedures
Company
Brandywine Urology
For over 35 years, Brandywine Urology Consultants has been dedicated to meeting the urologic needs of patients across Delaware, Maryland, Pennsylvania, and New Jersey.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Nathan Diller
Chief Operating Officer
Bruce N. Benge
Founding Partner
Company data provided by crunchbase