PRE-AUTHORIZATION SPECIALIST

Tri-State Orthopaedics; Delaware (OH); On-site; USD 42,000 - 54,000; Full time

Job summary

Tri-State Orthopaedics & Sports Medicine is seeking a full-time Diagnostic Imaging Pre-Authorization Specialist to join our busy practice. You will review clinical notes, verify benefits, and submit prior authorizations for MRI/CT scans for all providers, ensuring timely care.

Responsibilities include proactive tracking, scheduling urgent authorizations, and clear communication with providers, imaging facilities, staff and patients while staying current with payer guidelines and HIPAA compliance.

Qualifications

• High school diploma or equivalent required; associate degree or medical certification is a plus.
• 1–2 years in medical billing, insurance verification, or prior authorizations.
• Knowledge of CPT and ICD-10 medical coding.
• Familiarity with radiology/advanced imaging terminology is a plus.
• Strong computer literacy and experience with EHR systems.

Responsibilities

• Review clinical notes for required content and verify benefits.
• Submit prior authorizations for MRI/CT and track statuses.
• Monitor imaging requests and relay information to payers as needed.
• Obtain and schedule STAT/URGENT imaging prior authorizations.
• Communicate authorization status with providers, facilities, staff and patients.
• Facilitate peer-to-peer reviews or appeals for denials with payers and providers.
• Stay current with payer guidelines and authorization requirements.
• Return calls and emails promptly; answer basic authorization questions.

Skills

Customer service

Telephone skills

Computer literacy

Medical terminology

Education

High school diploma or equivalent

Associate degree or medical certification (preferred)

Tools

EHR systems

Job description

Tri-State Orthopaedics & Sports Medicine is an independent, well-respected and busy orthopaedic group reaching a milestone this year after providing the Pittsburgh region with the most advanced orthopaedic care for a variety of orthopaedic conditions and injuries for the past 50 years. As we prepare for the future, we are actively recruiting for a full-time Diagnostic Imaging Pre-Authorization Specialist to join our ever-expanding Practice.

Responsibilities:

• Reviewing clinical notes for required content, verifying insurance benefits, submitting requests through payer portals and tracking statuses to prevent delays in care and/or denied claims
• Completing and processing prior insurance authorizations for MRI/CT scans for all Providers in the practice
• Proactively monitoring, including tracking pending imaging requests and actively providing information to the insurance companies as needed for approval and addressing problems/concerns before they impact patient care
• Obtaining and scheduling STAT/URGENT imaging prior authorizations for necessary exams
• Assisting and communicating authorization status with providers, imaging facilities, clinical staff and patients
• Facilitating peer-to-peer conversations, reviews or appeals for denied authorizations with insurance companies and Providers and addressing inquiries from Providers, staff and patients
• Remaining current with payer guidelines and authorization requirements
• Returning patient and imaging facility phone calls and email correspondence in a timely manner; answering basic imaging prior authorization-related questions regarding the process
• Maintaining confidentiality and complying with HIPAA regulations

Requirements:

Candidates must possess strong telephone and computer skills and demonstrate the ability to provide exceptional customer service with a positive and upbeat attitude in a fast-paced practice environment. Understanding of basic medical terminology and medical office experience required.

Qualifications:

• High school diploma or equivalent; associate degree or medical certification is a plus
• One to two years of experience in medical billing, insurance verification, or prior authorizations
• Knowledge of CPT and ICD-10 medical coding
• Familiarity with medical terminology for radiology and advanced imaging is a plus
• Strong computer literacy and experience with electronic health record (EHR) systems