Prior Authorization & Verification Specialist

Advanced Radiology Consultants; Shelton (CT); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical coverage

Vision coverage

HSA with matching

PTO

Paid Holidays

401(k)

Life Insurance

Job summary

Advanced Radiology Consultants is seeking an Authorization & Verification Specialist in Shelton, CT. The role reviews radiology orders for accuracy, verifies patient demographics, insurance eligibility, and authorization requirements for imaging exams.

You will initiate and track prior authorizations, document activity in the patient record, and communicate status to providers, staff, payers, and patients while adhering to HIPAA regulations and internal policies.

Qualifications

• High school diploma or GED required.
• Knowledge of insurance eligibility, benefits, and prior authorization processes.
• 1–3 years healthcare administrative experience preferred.
• EPIC or similar EMR experience preferred.

Responsibilities

• Review provider orders/referrals for demographic, insurance, CPT, and clinical documentation for accuracy.
• Verify insurance eligibility, benefits, and prior authorization requirements.
• Initiate, track, and validate prior authorizations by payor guidelines.
• Confirm accuracy of authorizations received from referring offices.
• Document authorization activity and communications in the patient record.
• Communicate authorization status, issues, and denials to providers, staff, payers, and patients.
• Ensure compliance with payer policies, timelines, and HIPAA regulations.
• Participate in required meetings, training, and professional development sessions.
• Adhere to internal policies, procedures and documented workflow.
• Other duties as assigned.

Skills

Multitasking

Customer service

Data entry

Medical terminology

ICD-10/CPT

Problem-solving

De-escalation

Education

High school diploma or GED

Tools

EPIC EMR

Job description

Advanced Radiology Consultants is seeking an Authorization & Verification Specialist in Shelton, CT. The role reviews radiology orders for accuracy, verifies patient demographics, insurance eligibility, and authorization requirements for imaging exams.

You will initiate and track prior authorizations, document activity in the patient record, and communicate status to providers, staff, payers, and patients while adhering to HIPAA regulations and internal policies.