Radiology & DME Prior Authorization Specialist

Trinity Health; Azusa (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Trinity Health Medical Group in California is seeking an experienced Authorization Specialist to review, submit, monitor, and resolve medical necessity prior authorizations for high-tech radiology services and DME across multiple offices.

The role requires reviewing patient history, communicating with insurers, obtaining approvals, and updating the EMR while supporting staff through training and process improvements.

Qualifications

• Undergraduate degree or Associate’s degree in healthcare or graduate of an accredited program such as LPN, PTA, Radiology Technician/Technologist, Respiratory Therapy, Ultrasound or Medical Assistant.

Responsibilities

• Review, submit, monitor and respond to prior authorizations for high-tech radiology services and/or DME.
• Communicate with ordering providers and insurance representatives on next steps.
• Review patient history and documentation to identify supporting information for testing.
• Update EMR with approval/denial information and track status with ordering physician.
• Obtain authorizations, monitor in-basket and communications, and mentor staff as needed.
• Contribute to training and participate in required meetings and committees.

Skills

Insurance processes

Medical terminology

EMR proficiency

Education

Healthcare degree or certificate

Job description

Trinity Health Medical Group in California is seeking an experienced Authorization Specialist to review, submit, monitor, and resolve medical necessity prior authorizations for high-tech radiology services and DME across multiple offices.

The role requires reviewing patient history, communicating with insurers, obtaining approvals, and updating the EMR while supporting staff through training and process improvements.