PRE-AUTHORIZATION SPECIALIST

Tri-State Orthopaedics; Pittsburgh (Allegheny County); On-site; USD 42,000 - 56,000; Full time

Job summary

Tri-State Orthopaedics & Sports Medicine in Pittsburgh is hiring a full-time Diagnostic Imaging Pre-Authorization Specialist to manage prior authorizations for MRI and CT scans, verify benefits, submit requests through payer portals, and coordinate with providers, imaging facilities and patients to prevent delays in care.

The role requires strong phone and computer skills, knowledge of CPT and ICD-10 codes, and experience in medical billing or insurance verification; familiarity with EHR systems

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

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

Skills

Phone skills

Customer service

Medical terminology

CPT/ICD-10 coding

EHR software

Insurance verification

Prior authorizations

MRI/CT workflow

Education

High school diploma or equivalent

Associate degree or medical certification is a plus

Tools

EHR systems

Payer portals

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

We invite you to visit our website, www.tristateortho.com to learn more about our Practice.