Pre-Authorization Specialist

Invision Sally Jobe•Englewood, CO

3d•Onsite

About The Position

The Pre-Authorization Specialist handles complex authorization requests for radiology imaging services. The role requires advanced knowledge of payer guidelines, prior authorization workflows, and insurance policies to secure accurate approvals and help minimize denials. The specialist serves as a subject matter expert and works with referring providers, insurance representatives, and internal billing and denial management teams. The position is based in Englewood, Colorado, and is 100% in-office, with a hybrid schedule potentially available based on performance metrics. It reports to the Manager, Revenue Cycle Operations.

Requirements

At least 2–3 years of experience in the medical field, preferably in radiology or diagnostic imaging.
In-depth knowledge of commercial, Medicare, and Medicaid payer policies and authorization requirements.
Experience with electronic health records (EHR), radiology information systems (RIS), and payer portals.
Strong problem-solving skills and the ability to work independently.
Excellent communication and organizational skills, with attention to detail.
Ability to manage multiple priorities in a fast-paced environment.
Ability to read, write, and speak 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 in compliance with payer-specific guidelines.
Identify and resolve authorization issues to prevent delays in patient care.
Work with referring providers to obtain clinical documentation needed for authorization approvals.
Analyze payer trends to identify common denial reasons and implement proactive solutions.
Collaborate with billing and denial management teams to resolve authorization-related denials and appeals.
Maintain relationships with insurance representatives and stay informed about policy changes.
Document authorization activities accurately and in detail in the system.
Recommend workflow improvements to enhance efficiency and reduce authorization turnaround times.
Ensure compliance with HIPAA and payer-specific regulations.