Authorization Specialist

Rhode Island Medical Imaging; Warwick (RI); Hybrid; USD 42,000 - 61,000; Full time

Job summary

Rhode Island Medical Imaging is seeking a billing professional to obtain prior authorizations, verify insurance, and collect balances. You will assist patients with questions on coverage and payments, supporting cash flow for the organization.

Role requires accuracy in CPT/HCPCS/ICD-10 coding, knowledge of payer guidelines, and the ability to work with a team in a fast-paced imaging environment. The position offers on-site training at Warwick, RI and will transition to hybrid work after training.

Qualifications

• Knowledge of third-party billing requirements.
• Ability to collect payments sensitively yet effectively.
• Adapt to changes in collection rules by law or management.
• Team-oriented and able to work with others.
• Excellent telephone and interpersonal skills.
• Bilingual is a plus.

Responsibilities

• Obtain prior authorizations for selected exams and document accordingly.
• Verify insurance and collect out-of-pocket expenses prior to exams.
• Explain coverage and payment questions to patients.
• Process daily eligibility reports to verify insurance.
• Use billing and scheduling software to maintain workflow.
• Complete HCFA 1500 form and stay updated on billing guidelines.
• Use CPT/HCPCS/ ICD-10 codes in daily workflow.
• Coordinate with supervisor to ensure accounts remain collectable.
• Stay informed on insurance policy changes.
• Maintain professionalism and HIPAA compliance.
• Attend meetings and perform other duties as assigned.

Skills

Billing knowledge

Communication

Teamwork

Decision making

Phone skills

Bilingual

Education

High school diploma

Insurance billing courses

Medical terminology

Tools

Billing software

Job description

This position will transition to a hybrid role once the employee is fully trained and receives management approval. Training will be completed on-site at our corporate office in Warwick, RI.

Responsible for obtaining prior authorizations, verifying insurance, and the collection of selected accounts for Rhode Island Medical Imaging. This position also assists patients with questions regarding coverage and payment issues and serves as a key component of the cash flow for the institution.

SCHEDULE:

• Monday-Friday 9:30 AM-6:00 PM

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Obtain prior authorizations from insurance companies for selected exams and document accordingly within the company system.
• Obtain insurance verifications and out of pocket expenses for patients prior to their exams.
• Communicate out of pocket expenses to the patient and note accounts accordingly.
• Assist patients with questions regarding their benefits and out of pocket expenses in an efficient and professional manner.
• Work daily eligibility reports for hospital sites to verify insurance information.
• Effectively utilize billing and scheduling software to ensure efficient workflow.
• Understand the elements associated with completing the HCFA 1500 billing form for payor(s). Understand and resource billing guidelines for each payor; stay informed on related changes.
• Utilize CPT codes, HCPC codes, and ICD-10 codes in daily workflow. Use department and payor resources to ensure that accounts are accurate and complete.
• Take initiative and alert Management to possible issues or concerns.
• Crosstrain and fill in for other team members when directed by Management.
• As needed, enlist the help of the Supervisor to ensure that accounts remain collectable.
• Stay informed on insurance changes regarding policy and coverage guidelines.
• Maintain professionalism at all times and adhere to all company policies and procedures.
• Consistently apply the corporate values of respect, honesty, fairness, and constant pursuit of excellence in improving local patient health status through the provision of customer-friendly, geographically accessible, and high-value services within the environment of a diagnostic imaging company.
• Ensure that all interactions are in compliance with HIPAA and federal compliance regulations.
• Participate in meetings as requested.
• Perform other duties as assigned.

BASIC KNOWLEDGE/SKILLS:

• Must have knowledge of third-party billing requirements.
• Ability to maintain sensitivity to the delicate nature of collecting payments for medical services while remaining effective in securing those payments.
• Ability to adapt, in a timely manner, to changes in collection rules as defined by State and/or Federal law and/or Management.
• Ability to work in a team environment.
• Must be able to make decisions and manage/prioritize workloads.
• Must have excellent telephone and interpersonal skills.
• Bilingual is a plus.

EXPERIENCE:

• One year of Prior Authorization experience preferred.

EDUCATION

• High school diploma or equivalent.
• Additional courses in insurance billing, computer basics, and medical terminology preferred.

PHYSICAL DEMANDS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.This description is not intended to be a complete statement of the position, but rather to act as a guide to the general work to be performed.The requirements are representative of the knowledge, skill, and/or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.The individual's competencies and customer requirementsimpactthe actual role performed.

Join an award-winning organization! With numerous private, state-of-the-art medical diagnostic imaging facilities, join the team that has been providing Rhode Island with imaging excellence for over 80 years! The American College of Radiology has named RIMI one of the first outpatient diagnostic imaging Centers of Excellence in the country and the first in Rhode Island. RIMI also has the honor of being named an eight-time winner of Providence Business News' Healthiest Employers of Rhode Island Award, most recently in 2025!

RIMI offers best-in-class benefits to eligible employees including multi-tiered health plans, flexible spending accounts, generous paid time off, 401(k) plan with profit sharing component, uniform reimbursement, company "swag," yearly reimbursement for continuing medical education, educational assistance (reimbursement) program, student loan repayment program, and career development opportunities. Enjoy competitive pay and all in our innovative culture that consistently provides the highest levels of quality, safety, technology, and patient care.

Equal Opportunity Employer
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