Pre-Authorization Specialist

Invision Sally Jobe•Englewood, CO

1d•$20 - $24•Onsite

About The 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.

Requirements

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

Nice To Haves

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.

Responsibilities

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.
Maintain strong relationships with insurance representatives to stay updated on policy changes.
Document all authorization activities in the system with accuracy and detail.
Recommend workflow improvements to enhance efficiency and reduce authorization turnaround times.
Ensure compliance with HIPAA and payer-specific regulations.