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.
Maintain strong relationships with insurance representatives to stay updated on policy changes.
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.

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.

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

Pre-Authorization Specialist

Key skills