Prior Authorization Assistant – Imaging/Radiology

This is a fully remote position, open to applicants in United States.

📋 Description

• Handle prior authorizations directly, often managing a high volume of requests.

• Act as a primary resource for fellow Ascertain Assistants.

• Partner with Ascertain leadership and product teams to develop AI-enhanced prior authorization workflows.

• Collaborate with radiology facilities and imaging centers to alleviate administrative burdens and optimize workflows.

• Process authorizations manually and supervise automated submissions for MRI, CT, PET, nuclear medicine, diagnostic radiology, interventional radiology, and related referrals.

• Review and confirm insurance details and patient eligibility.

• Collect clinical documentation from ordering providers and imaging teams, including indications, prior imaging, and supporting records.

• Submit prior authorization requests to payors following established protocols and payor-specific imaging guidelines.

• Monitor and track requests to ensure timely processing and resolution, including those that are scheduling-sensitive and urgent.

• Address inquiries from providers, patients, and payors regarding authorization status.

• Manage denials and peer-to-peer requests while providing support for appeals.

• Maintain precise records of authorization requests, approvals, and denials.

• Work with internal teams to resolve authorization issues and enhance process efficiency.

• Stay updated on payor policies, radiology benefit manager requirements, regulations, and industry trends that impact imaging authorizations.

⛳️ Requirements

• Over 4 years of experience in prior authorization and billing within radiology and/or diagnostic imaging.

• Proficiency with athenahealth and/or NextGen systems.

• Knowledge of major payors, including UnitedHealthcare, Aetna, and Blue Cross Blue Shield.

• Familiarity with radiology benefit managers such as EviCore and Carelon (formerly AIM).

• Experience in prior authorization and billing in oncology, including oncologic imaging and PET/CT.

• Proven leadership experience, such as Team Lead, Supervisor, or informal leadership roles.

• Willingness to adopt a hands-on approach.

• High attention to detail and commitment to authorization accuracy.

• Effective collaboration and communication with providers, teammates, and cross-functional stakeholders.

• Ability to adapt between manual workflows and AI-assisted tools.

• Demonstrated empathy when engaging with providers and patients.

• Process-oriented mindset focused on established workflows and process enhancement.

🏝️ Benefits

• Equity.

• Opportunity to make a significant impact on healthcare organizations and patient care.

• Chance to work with innovative AI-powered healthcare technology.

• Extensive exposure to various specialties, external stakeholders, and departments across Ascertain.