Invision Sally Jobe / Radiology Imaging Associates
Pre-Authorization Specialist
Invision Sally Jobe / Radiology Imaging Associates, Englewood, Colorado, us, 80151
Pre-Authorization Specialist | Englewood, CO
Reporting to Manager, Revenue Cycle Operations
Employment Type: Full Time
This role is 100% in-office, but may be considered for hybrid schedule based upon performance metrics.
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 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 providing them with the highest quality imaging and associated medical care.
Summary of Position:
The Prior Authorization Specialist is responsible for handling complex authorizations 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. Primary Responsibilities Prior Authorizations: 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.
Problem Solving & Denial Prevention:
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.
Communication & Coordination:
Maintain strong relationships with insurance representatives to stay updated on policy changes. Document all authorization activities in the system with accuracy and detail.
Process Improvement & Compliance:
Recommend workflow improvements to enhance efficiency and reduce authorization turnaround times. Ensure compliance with HIPAA and payer-specific regulations.
Qualifications
Minimum of 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 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.
Preferred Qualifications
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.
Compensation & Benefits
Compensation for this role ranges from $20.00 to $24.00 per hour. This range is Radiology Imaging Associates reasonable estimate of base compensation and is based on non-discriminatory factors such as experience, knowledge, skills, and abilities. Radiology Imaging Associates offers a comprehensive benefits package including medical, dental, vision, life insurance, AD&D, EAP, Short Term Disability, Long Term Disability, PTO and holiday pay for eligible employees. Optional voluntary benefits include supplemental life insurance, accident, and critical illness. A 401(k) retirement plan with potential profit sharing and tuition reimbursement is available. Full-time employees become eligible for benefits on the first of the month following 30 days of employment. Note: Some benefits may be pro-rated for part-time employees. #J-18808-Ljbffr
The Prior Authorization Specialist is responsible for handling complex authorizations 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. Primary Responsibilities Prior Authorizations: 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.
Problem Solving & Denial Prevention:
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.
Communication & Coordination:
Maintain strong relationships with insurance representatives to stay updated on policy changes. Document all authorization activities in the system with accuracy and detail.
Process Improvement & Compliance:
Recommend workflow improvements to enhance efficiency and reduce authorization turnaround times. Ensure compliance with HIPAA and payer-specific regulations.
Qualifications
Minimum of 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 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.
Preferred Qualifications
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.
Compensation & Benefits
Compensation for this role ranges from $20.00 to $24.00 per hour. This range is Radiology Imaging Associates reasonable estimate of base compensation and is based on non-discriminatory factors such as experience, knowledge, skills, and abilities. Radiology Imaging Associates offers a comprehensive benefits package including medical, dental, vision, life insurance, AD&D, EAP, Short Term Disability, Long Term Disability, PTO and holiday pay for eligible employees. Optional voluntary benefits include supplemental life insurance, accident, and critical illness. A 401(k) retirement plan with potential profit sharing and tuition reimbursement is available. Full-time employees become eligible for benefits on the first of the month following 30 days of employment. Note: Some benefits may be pro-rated for part-time employees. #J-18808-Ljbffr