Insurance PRe-Authorizations

Eastern Radiologists, Inc.; Greenville (NC); On-site; USD 25,000 - 39,000; Full time

Job summary

Eastern Radiologists, Inc. is seeking an Insurance Pre-Authorization specialist to verify insurance coverage, obtain prior authorizations, and validate medical necessity for diagnostic imaging and outpatient radiology services.

The role collaborates with insurers, referring providers, clinical staff, and scheduling teams to ensure authorizations are completed before services are rendered. You will help minimize denials, ensure accurate patient and payer information, and support compliant

Qualifications

• High school diploma or GED is required; an associate degree is preferred.
• Experience with insurance and CPT codes is desirable.
• Must be able to communicate clearly and maintain confidentiality.

Responsibilities

• Verify patients' insurance eligibility, active coverage, benefits, and plan requirements for radiology services.
• Verify prior authorizations for applicable imaging procedures and obtain authorization as needed.
• Review and validate authorization details against scheduled services.
• Confirm clinical documentation and diagnosis codes meet payer guidelines and medical necessity.
• Contact insurers to obtain authorization status and clarify requirements.
• Identify and address authorization issues to prevent claim denials.
• Coordinate with scheduling staff and providers to communicate authorization status and timelines.
• Document authorization numbers, dates, and related references in the EHR system.

Skills

Insurance verification

Prior authorization

Medical records review

Communication skills

Data entry accuracy

Education

High school diploma or GED

Associate degree preferred

Job description

Job Summary

The Insurance Pre-Authorization position is responsible for verifying insurance coverage, verifying prior authorizations with the correct diagnosis and CPT Code, and validating medical necessity requirements for diagnostic imaging and outpatient radiology services. This position works closely with insurance carriers, referring providers, clinical staff, and scheduling teams to ensure all authorization requirements are met before services are rendered. The role helps minimize claim denials, prevent delays in patient care, and support accurate reimbursement by ensuring patient and insurance information is complete, accurate, and compliant with payer guidelines.

Major Job Functions

• Insurance Verification: Verify patients' insurance eligibility, active coverage, benefits, and plan requirements for scheduled outpatient radiology and diagnostic imaging services.
• Prior Authorization Processing: Verify prior authorizations from insurance companies for applicable imaging procedures before the scheduled date of service. Using insurance portals and telephone calls to obtain information. It may require calls to the referring provider to obtain authorization for services.
• Authorization Validation: Review and validate authorization details to ensure the approved procedure, CPT code, diagnosis, rendering facility, provider, number of visits, and authorization dates match the scheduled service.
• Medical Necessity Review: Confirm that required clinical documentation, physician orders, diagnosis codes, and supporting medical records meet insurance payer guidelines and medical necessity criteria. If an ABN is required, it will be necessary to discuss this with the patient.
• Insurance Payer Communication: Contact insurance companies, utilization management departments, and third-party authorization vendors to obtain authorization status, clarify requirements, resolve discrepancies, and facilitate timely approvals.
• Denial Prevention and Resolution: Identify authorization-related issues that may result in claim denials, address missing or incorrect information, and coordinate corrections or additional documentation before services are performed.
• Patient Scheduling Coordination: Collaborate with scheduling staff, referring providers and clinical teams to communicate authorization status, identify pending approvals, and help prevent unnecessary appointment delays or cancellations.
• Authorization Documentation and Data Entry: Accurately document authorization numbers, approval dates, approved services, reference numbers, payer communications, and outstanding requirements in the practice management or electronic health record system.
• Work Queue and Deadline Management: Monitor authorization work queues, prioritize time-sensitive and high-cost imaging procedures, follow up on pending requests, and ensure authorizations are completed within established turnaround times.
• Compliance and Quality Assurance: Maintain compliance with payer-specific policies, organizational procedures, patient privacy requirements, and applicable regulatory standards while identifying opportunities to improve authorization accuracy and workflow efficiency.

Specifications

• Education: A high school diploma or GED required. Associate degree or higher preferred.
• Experience: Medical office or customer service required. Experience with insurance and CPT Code preferred.
• Certification/License/Registration: None
• Position Titles and Number Supervised: None
• Special Training/Skills: Must be able to remain calm in stressful situations. Must display courtesy and empathy toward patients, co-workers, and physicians. Must be able to make sound judgments and execute the appropriate actions based on the needs of patients and knowledge of departmental policies and procedures. Must have good communication skills and be discrete with confidential information. Demonstrate punctuality and dependability and ability to make good use of clinical time.
• Physical Demands: Must be able to move about freely. Must be able to assist in the lifting of physically compromised patients. Must possess sufficient visual and auditory acuity do perform tasks remotely located to the patient.
• Working Conditions: Works in a medical facility. Subject to electrical, chemical, and radiant energy hazards. Exposure to infectious disease and lifting hazards. Sits, stands, and walks intermittently throughout the day. Must stoop and bend in the course of job performance. Must lift patients, film cassettes, and supplies.
• Other (Operational Excellence): Employee must be aware of and fully support all practice policies and procedures. Must have demonstrated ability to deliver services to physicians, patients and fellow employees with compassion and in a responsive, courteous and concerned manner.