Precertification Specialist at Lehigh Valley Imaging LLC – Allentown, Pennsylvania

Lehigh Valley Imaging is currently hiring for the position of MRI Precertification Specialist. This is a full-time, first shift, in-person only position working from our Allentown, PA office Monday through Friday from 9:30 am to 6:00 pm.

Performs billing and outpatient registration duties, including but not limited to, contacting patients regarding out-of-pocket expenses, educating patients on their benefits, and making them aware of any pre-certification issues while speaking to them in a professional and courteous manner.

Duties:

* Responsible for the completion of patient registrations, e-verifications, and creation of HAR for upcoming MRI appointments.

* Verify eligibility and benefits via website (Navinet, Evicore, etc.) or phone.

* Run e-verification and benefits through Epic.

* Check One Source for E-Care alerts and make any necessary corrections daily.

* Enter note in DAR when everything has been verified and MRI can be performed.

* Check assigned DAR routinely for add-on outpatients.

* Responsible for obtaining and verifying pre-certifications for MRI.

* Contact referring physician office to obtain pre-certification or start pre-certification if it is a referring physician office that we do pre-certifications for.

* Follow up until pre-certification is complete.

* Verify authorization details including authorization number, validity date, CPT code, location and insurance ID number.

* Contact referring physician office is peer-to-peer is needed, document denial reason and peer-to-peer contact information in patient referral shell.

* Notify patient as soon as possible of any pre-certification issues that may result in cancelation of stody.

* Responsible for running estimates in Epic and contacting patients regarding out of pocket expenses.

* Work on retro authorizations and denials as assigned by Billing Supervisor and/or Manager.

* Review payment options available to patient including Financial Assistance Program (FAP) and offer to transfer them to patient account if patient expresses an inability to pay.

* Take yearly RCE competency exam and receive at least 80% passing grade.

* Responsible for answering phone calls and maintaining a courteous disposition during calls.

Education & Experience:

* High school graduate or equivalent required.

* Customer service experience required.

* Knowledge of medical terminology and ICD-10 preferred.

* Knowledge of procedure authorization and its direct impact on the practice's revenue cycle.