PRE-AUTHORIZATION SPECIALIST

PRE-AUTHORIZATION SPECIALIST

Tri-State Orthopaedics & Sports Medicine is an independent, well-respected and busy orthopaedic group reaching a milestone this year after providing the Pittsburgh region with the most advanced orthopaedic care for a variety of orthopaedic conditions and injuries for the past 50 years. As we prepare for the future, we are actively recruiting for a full-time Diagnostic Imaging Pre-Authorization Specialist to join our ever-expanding Practice.

Responsibilities:

• Reviewing clinical notes for required content, verifying insurance benefits, submitting requests through payer portals and tracking statuses to prevent delays in care and/or denied claims
• Completing and processing prior insurance authorizations for MRI/CT scans for all Providers in the practice
• Proactively monitoring, including tracking pending imaging requests and actively providing information to the insurance companies as needed for approval and addressing problems/concerns before they impact patient care
• Obtaining and scheduling STAT/URGENT imaging prior authorizations for necessary exams
• Assisting and communicating authorization status with providers, imaging facilities, clinical staff and patients
• Facilitating peer-to-peer conversations, reviews or appeals for denied authorizations with insurance companies and Providers and addressing inquiries from Providers, staff and patients
• Remaining current with payer guidelines and authorization requirements
• Returning patient and imaging facility phone calls and email correspondence in a timely manner; answering basic imaging prior authorization-related questions regarding the process
• Maintaining confidentiality and complying with HIPAA regulations

Requirements:

Candidates must possess strong telephone and computer skills and demonstrate the ability to provide exceptional customer service with a positive and upbeat attitude in a fast-paced practice environment. Understanding of basic medical terminology and medical office experience required.

Qualifications:

• High school diploma or equivalent; associate degree or medical certification is a plus
• One to two years of experience in medical billing, insurance verification, or prior authorizations
• Knowledge of CPT and ICD-10 medical coding
• Familiarity with medical terminology for radiology and advanced imaging is a plus
• Strong computer literacy and experience with electronic health record (EHR) systems