Senior Prior Authorization and Benefits Eligibility Specialist

Invision Sally Jobe • Englewood, CO

2d • $22 - $30 • Onsite

About The Position

Invision Sally Jobe (ISJ) is a network of imaging centers built and managed through a partnership between Radiology Imaging Associates and HealthOne. Our imaging centers are conveniently located throughout the South Denver area and offer a variety of exams using state of the art equipment. Our services include MRI, CT, digital mammography, ultrasound, pain management, DXA, X-Ray, and image guided biopsies. Our mission is to improve the health of patients in the communities we serve by proving them with the highest quality imaging and associated medical care. The Senior Authorization and Benefits Eligibility Specialist is responsible for handling complex authorization and insurance verification processes 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 and resource for the team, assisting with training and escalated cases.

Requirements

• Minimum of 2-3 years of experience in medical insurance authorization and benefits verification, 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 on complex cases.
• 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

• 5+ years of experience in medical insurance authorization and benefits verification, 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

• Perform detailed eligibility and benefits verification for MRI, CT and other radiology services
• 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.
• Serve as a resource for complex cases, assisting with escalations and troubleshooting issues.
• Maintain strong relationships with insurance representatives to stay updated on policy changes.
• Educate clinical and administrative staff on payer authorization requirements.
• 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.

Benefits

• Medical, dental, and vision insurance
• Term life insurance, AD&D, and EAP
• Long Term Disability
• Generous Paid Time Off
• Paid holidays
• Voluntary income protection options (ie. supplemental life insurance, accident, critical illness)
• Profit-sharing
• 401(k) retirement plan
• Tuition reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed