Pre-Authorization Specialist

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 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.

Summary of 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.

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 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 for this role between $20.00 to $24.00 per hour.

In accordance with Colorado law, the range provided is Radiology Imaging Associate's reasonable estimate of the base compensation for this role, 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, term life insurance, AD&D, EAP, Short Term Disability, Long Term Disability, PTO and holiday pay for eligible employees. There are also options for voluntary income protection benefits i.e. supplemental life insurance, accident, and critical illness, profit sharing 401(k) retirement plan, and tuition reimbursement. Part-time employees may have access to some of these benefits, which may be on a pro-rated basis. Full-time employees will become eligible for benefits on the first of the month following 30 days of employment.

Equal Opportunity Employer
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