PRE-AUTHORIZATION SPECIALIST - DIAGNOSTIC IMAGING

Tri-State Orthopaedics; Pittsburgh (Allegheny County); On-site; USD 52,000 - 68,000; Full time

Job summary

Tri-State Orthopaedics & Sports Medicine is seeking a full-time Diagnostic Imaging Pre-Authorization Specialist to join our established practice. You will review clinical notes, verify benefits and process prior authorizations for MRI and CT imaging across providers.

In this fast-paced environment, you will monitor requests, communicate with insurers, and support providers, staff and patients with timely authorization decisions while maintaining HIPAA compliance.

Qualifications

• High school diploma or equivalent; associate degree or medical certification is a plus.
• 1-2 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 is a plus.

Responsibilities

• Review clinical notes for required content and verify insurance benefits.
• Submit prior authorizations for MRI/CT scans and track statuses.
• Monitor pending imaging requests and liaise with insurers to prevent delays.
• Obtain and schedule STAT/URGENT imaging prior authorizations as needed.
• Communicate authorization status with providers, imaging facilities, staff and patients.
• Facilitate peer-to-peer discussions or appeals for denied authorizations.

Skills

Telephone skills

Computer skills

Customer service

Medical terminology

Radiology terminology

Education

High school diploma

Associate degree or medical certification

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