Radiology Prior Authorization Specialist

Taglynk; Bengaluru; On-site; INR 600,000 - 900,000; Full time

Job summary

Taglynk is seeking a meticulous Radiology Prior Authorization Specialist to oversee the PA process for radiology services, ensuring timely approvals and adherence to payer guidelines.

You will collaborate with radiologists, technologists, and billing teams to secure essential imaging services while maintaining HIPAA compliance and accurate documentation.

Qualifications

• Experience in medical prior authorizations, preferably radiology or imaging services.
• Proficiency with EMR/RIS platforms and payer portals.
• Strong written and verbal communication to coordinate across departments and with insurers.

Responsibilities

• Manage Prior Authorization Process for radiology procedures and imaging services (MRI, CT, PET, Ultrasound).
• Review PA submissions for completeness and medical necessity against payer guidelines.
• Collaborate with radiology staff to collect and submit accurate clinical documentation.
• Coordinate with insurance carriers to resolve denials, manage appeals, and minimize delays.

Skills

Attention to Detail

Independent & Collaborative

Communication Skills

HIPAA Compliance

Medical Terminology

Education

Medical Coding Certification

Healthcare Administration Certification

HIPAA Training

Tools

EMR/RIS Platforms

Payer Portals

Job description

We are seeking a meticulous and proactive Radiology Prior Authorization Specialist to oversee and streamline the prior authorization (PA) process for radiology procedures. This role ensures timely and accurate approvals, reduces patient wait times, and supports compliance with payer requirements.

You will collaborate with radiologists, technologists, billing staff, and insurance providers to facilitate access to essential diagnostic and therapeutic radiology services.

Responsibilities

• Manage Prior Authorization Process: Handle the full lifecycle of prior authorizations for radiology procedures and imaging services (e.g., MRI, CT, PET, Ultrasound).
• Review Requests: Assess prior authorization submissions for completeness, ensuring alignment with medical necessity and payer guidelines.
• Team Collaboration: Work with radiologists, imaging departments, and billing teams to collect and submit accurate clinical documentation.
• Insurance Coordination: Communicate with insurance carriers to resolve denials,manage appeals, and minimize barriers to timely care.
• Maintain Records: Keep detail edand compliant records of all authorizations, including statuses and correspondence.
• Problem Resolution: Identify issues early in the process and implement solutions to accelerate authorization turnaround times.
• Stay Current: Monitor updates in payer policies and new radiology technologies/procedures to ensure workflow compliance.
• Process Improvement: Provide actionable insights to improve the radiology PA workflow.
• Technology Utilization: Use EMRs (e.g., Radiology Information Systems) and PA platforms to manage submissions.
• Regulatory Compliance: Ensure all processes and documentation meet HIPAA and related standards.

Qualifications

• Experience: Minimum of 3 years handling medical prior authorizations, preferably in radiology or imaging services.
• Preferred Background: Experience in a radiology center or working with radiology teams is highly desirable.
• Technical Knowledge: Familiarity with radiology procedures, medical necessity criteria,and insurance pre-certification processes.
• Systems & Tools:Proficient with EMR/RIS platforms and payer portals.
• Communication: Strong written and verbal communication skills to coordinate across departments and with insurers.
• Attention to Detail:Ability to manage multiple requests and maintain accuracyunder time pressure.
• Independence & Collaboration: Capable of working autonomously while engaging effectively with clinical teams.
• Compliance: Deep understanding of HIPAA and regulatory frameworks.
• Certifications (Preferred): Medical Coding,Healthcare Admin, or similar qualifications.