Pre-Authorization Specialist

Riaco; Englewood (CO); In loco; USD 28.000 - 33.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical insurance

Dental insurance

Vision insurance

Term life insurance

AD&D

EAP

PTO and holidays

Descrizione del lavoro

Radiology Imaging Associates in Englewood, CO is seeking a Pre-Authorization Specialist to manage complex radiology prior authorizations, ensuring payer guideline compliance and minimizing denials. This 100% in-office role may transition to a hybrid schedule based on performance.

You will collaborate with referring providers, billing and denial teams, and maintain accurate documentation. A minimum of 2–3 years in medical imaging is required, with EHR/RIS and payer portal experience.

Competenze

• 2–3 years of experience in the medical field, preferably radiology or diagnostic imaging.
• Knowledge of commercial, Medicare, and Medicaid payer policies and authorization requirements.
• Experience with EHR, RIS, and payer portals.
• Strong problem-solving skills and ability to work independently.
• Excellent communication and organizational skills.

Mansioni

• Secure prior authorizations from commercial and government payers per guidelines.
• Identify and resolve authorization issues to prevent delays in patient care.
• Work with referring providers to obtain clinical documentation for approvals.
• Analyze payer trends to identify denial reasons and implement solutions.
• Collaborate with billing and denial management to resolve denials and appeals.
• Maintain relationships with insurance representatives and document activities.
• Suggest workflow improvements and ensure HIPAA compliance.

Conoscenze

Problem solving

Communication

Organizational skills

Multitasking

Independent work

Strumenti

EHR

RIS

Payer portals

Epic

Cerner

Descrizione del lavoro

Pre-Authorization Specialist | Englewood, CO
Reporting to Manager, Revenue Cycle Operations
Employment Type: Full Time
This role is 100% in-office, but may be considered for hybrid schedule based upon performance metrics.

Summary of Position:

The Prior Authorization Specialist is responsible for handling complex authorization for radiology imaging services. This role requires advanced knowledge of payer guidelines, prior authorization workflows, and insurance policies to ensure accurate approvals and minimize denials. The specialist will serve as a subject matter expert.

Primary Responsibilities:

• Prior Authorizations:
  • Secure prior authorizations from commercial and government payers, ensuring compliance with payer-specific guidelines.
  • Identify and resolve authorization issues to prevent delays in patient care.
  • Work closely with referring providers to obtain necessary clinical documentation for authorization approvals.
• Analyze payer trends to identify common denial reasons and implement proactive solutions.
• Collaborate with the billing and denial management teams to resolve authorization-related denials and appeals.
• Communication & Coordination:
  • Maintain strong relationships with insurance representatives to stay updated on policy changes.
  • Document all authorization activities in the system with accuracy and detail.
• Process Improvement & Compliance:
  • Recommend workflow improvements to enhance efficiency and reduce authorization turnaround times.
  • Ensure compliance with HIPAA and payer-specific regulations.

Qualifications:

• Minimum of 2-3 years of experience in medical field preferably in radiology or diagnostic imaging.
• In-depth knowledge of commercial, Medicare, and Medicaid payer policies and authorization requirements.
• Experience working with electronic health records (EHR), radiology information systems (RIS), and payer portals.
• Strong problem-solving skills with the ability to work independently.
• Excellent communication and organizational skills with attention to detail.
• Ability to manage multiple priorities in a fast-paced environment.
• Must be able to read, write, and speak in English

Preferred Qualifications:

• 1-3 years of experience in medical insurance authorizations, preferably in radiology or diagnostic imaging.
• Experience with Epic, Cerner, or other RIS/PACS/EHR systems.
• Knowledge of medical coding (CPT, ICD-10) related to radiology services.
• Prior experience training or mentoring junior staff.

Compensation for this role between $20.00 to $24.00 per hour.

In accordance with Colorado law, the range provided is Radiology Imaging Associate’s reasonable estimate of the base compensation for this role, and is based on non-discriminatory factors such as experience, knowledge, skills, and abilities.

Radiology Imaging Associates offers a comprehensive benefits package including medical, dental, vision, term life insurance, AD&D, EAP, Short Term Disability, Long Term Disability, PTO and holiday pay for eligible employees. There are also options for voluntary income protection benefits i.e. supplemental life insurance, accident, and critical illness, profit sharing 401(k) retirement plan, and tuition reimbursement. Part-time employees may have access to some of these benefits, which may be on a pro-rated basis. Full-time employees will become eligible for benefits on the first of the month following 30 days of employment.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.