Radiology Prior Authorization Specialist

Trinityhealth; United States; On-site; USD 60,000 - 90,000; Full time

Job summary

Trinity Health Medical Group is seeking a dedicated Prior Authorization Specialist to review and submit medical necessity requests for high-tech radiology services and DME for IHA patients across multiple offices.

You will verify patient histories, contact insurers, obtain authorizations, and monitor status while updating EMR with decisions. The role requires strong knowledge of insurance processes and HIPAA compliance, and may mentor staff.

Qualifications

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

Responsibilities

• Review, submit, monitor and respond to issues regarding prior authorizations for high-tech radiology services, procedures, and/or DME.
• Communicate professionally with ordering providers, practice staff and insurance representatives.
• Review patient history and tests to identify supporting documentation for testing being ordered.
• Perform data collection and data review tasks as required.
• Contact insurance companies to obtain authorizations.
• Update EMR with approval/denial information and follow up with ordering physician as needed.
• Monitor in-basket, email and fax communications and follow up timely.
• Obtain urgent authorizations the same day or next day.
• Verify correct procedural and diagnostic codes and insurance verification.
• Monitor authorizations/denials and follow up as necessary.
• May mentor other team members and assist with staff training.

Skills

Medical terminology

Insurance processes

Prior authorization

Communication skills

Education

Undergraduate or Associate degree in healthcare

Job description

Trinity Health Medical Group is seeking a dedicated Prior Authorization Specialist to review and submit medical necessity requests for high-tech radiology services and DME for IHA patients across multiple offices.

You will verify patient histories, contact insurers, obtain authorizations, and monitor status while updating EMR with decisions. The role requires strong knowledge of insurance processes and HIPAA compliance, and may mentor staff.