Pre-Authorization Specialist

RIA; United States; Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Term life and AD&D

EAP

Short and long term disability

PTO and holiday pay

401(k) with matching

Tuition reimbursement

Voluntary benefits options

Job summary

Radiology Imaging Associates (RIA) is seeking a Pre-Authorization Specialist in Englewood, CO. The role is 100% in-office with potential hybrid scheduling based on performance metrics, reporting to the Manager of Revenue Cycle Operations.

The specialist handles complex radiology prior authorizations, collaborating with providers, payers, and billing to minimize denials and ensure timely patient care. Strong knowledge of payer guidelines and HIPAA compliance is essential.

Qualifications

• Minimum 2-3 years of medical field experience, radiology preferred.
• Knowledge of commercial, Medicare, and Medicaid payer policies and authorizations.
• Experience with EHR, RIS, and payer portals.
• Strong problem-solving skills with ability to work independently.
• Excellent communication and organizational skills.

Responsibilities

• Secure prior authorizations from payers, per guidelines.
• Identify and resolve authorization issues to avoid delays.
• Collaborate with referrers to obtain clinical documentation.
• Analyze payer trends to reduce denials and improve turnaround times.
• Document all authorization activities accurately in the system.
• Coordinate with billing and denial teams on denials and appeals.
• Maintain relationships with insurance representatives for policy updates.

Skills

Radiology experience

Payer policy knowledge

EHR / RIS experience

Communication skills

Organizational skills

Multitasking

English proficiency

Tools

Epic

Cerner

RIS/PACS/EHR systems

Job description

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.

Invision Sally Jobe (ISJ) is a network of imaging centers built and managed through a partnership between Radiology Imaging Associates and HealthOne. Our imaging centers are conveniently located throughout the South Denver area and offer a variety of exams using state of the art equipment. Our services include MRI, CT, digital mammography, ultrasound, pain management, DXA, X-Ray, and image guided biopsies. Our mission is to improve the health of patients in the communities we serve by proving them with the highest quality imaging and associated medical care.

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.