Prior Authorization and Scheduling Specialist - Interventional Radiology

Neuroscience Group is growing! We have a newly created position on our Prior Authorization and scheduling team that works primarily with Interventional Radiology. This position will work Monday - Friday 8 hours per day. As an integral member of the Patient Access Team, the Interventional Radiology (IR) Scheduling/Authorization Specialist will both schedule and obtain prior authorization for Interventional Radiology procedures performed by Neuroscience Group Interventional Radiologist taking place in partner hospital settings.

For over thirty years, Neuroscience Group has provided excellent neurologic care for the Fox Valley and Northeast Wisconsin. Ours is the only medical facility in the area that combines neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management and physical therapy. Our practice has grown to over 50 providers and serves patients in nine outlying clinics scattered throughout the region. Our mission is to improve lives by providing the very best in brain, spine and pain care and we do that by living our company core values: compassionate care, teamwork, fiscal responsibility, continuous learning, leadership and community involvement.

RESPONSIBILITIES:

Prior Authorization:

• Verifies and reviews all patient insurance information as it applies to the pre-certification process
• Verifies correct CPT and DX codes for the requested procedure(s)
• Determine necessity for pre-authorization
• Reviews chart documentation to ensure patient meets medical policy guidelines
• Obtains authorization via payer website, phone or fax form depending on insurance requirements
• Communicates with the involved parties regarding benefit eligibility and other financial issues
• Notifies patients and practitioners of any services requested and/or referred that are not authorized by insurance; schedules Peer to Peer consults for denied authorizations
• Assists with submission of appeal letters/clinicals if needed
• Follows up regularly on pending cases
• Responds to both written and oral correspondence regarding scheduling changes/cancellations in a timely and accurate manner

Interventional Radiology Scheduling

• Schedule hospital-based IR procedures for patients with appropriate provider and facility using computerized scheduling programs
• Uses Epic chat and Google Doc program to communicate scheduling of procedures
• Informs equipment representatives of upcoming procedure, providing accurate facility location, date and time, and any changes that occur
• Schedule all preoperative and postoperative appointments regarding the procedure
• Completes and faxes any required pre op testing orders to appropriate locations if applicable
• Confirms procedure authorization is valid and informs IR authorization representative if update is necessary
• Answers incoming calls and schedules/confirms patient procedures, along with any related appointments using proper telephone etiquette
• Coordinates the related documentation and communication, including adding important details to education letter in Epic to be finished by IR triage team