Prior Authorization Specialist

This is a fully remote position, open to applicants in Alabama, +6 more states.

📋 Description

• Acquire prior authorizations for imaging procedures such as MRI, CT, PET, Nuclear Medicine, Fluoroscopy, Interventional Radiology, Mammography, Ultrasound, X-ray, and Bone Densitometry.

• Confirm insurance eligibility, benefits, and authorization criteria.

• Ensure accurate CPT and ICD-10 coding for all scheduled examinations.

• Reach out to referring physician offices and insurance providers to gather necessary documentation.

• Review medical records to validate medical necessity.

• Input authorization numbers and comprehensive documentation into the RIS system.

• Inform patients about insurance and authorization processes.

• Reschedule appointments for patients when authorization is still pending.

• Provide pricing estimates and clarify financial assistance options.

• Uphold HIPAA compliance and maintain patient confidentiality.

• Collaborate with technologists, front desk personnel, and scheduling teams to ensure the accuracy of exams.

• Verify that scheduled imaging exams are authorized for the appropriate facility, adhere to medical necessity standards, and comply with insurance carrier and HIPAA regulations.

• Operate within established guidelines and under direct supervision within Health Information Management, Patient Access, and Scheduling functions.

⛳️ Requirements

• Candidates must reside in Alabama, Arizona, Georgia, Idaho, North Carolina, Texas, Utah, or Washington.

• High School Diploma or GED is required.

• Formal training in medical terminology or equivalent experience in a medical office is necessary.

• A minimum of 3 years of experience in medical office insurance authorization is required.

• Proficiency in CPT and ICD-10 coding is essential.

• Experience navigating insurance websites for eligibility and claim status is required.

• Understanding of radiology procedures and authorization workflows is important.

• Strong attention to detail and the capability to manage multiple tasks are crucial.

• Effective written and verbal communication skills are necessary.

• Professional customer service skills are required.

• Clinical experience in a radiology or imaging environment is preferred.

• Familiarity with RIS systems is preferred.

• Experience with PET scan authorization processes is preferred.

• Knowledge of HCPCS coding is preferred.

• Ability to work Monday through Friday, from 9:00 AM to 5:30 PM Pacific Time.

• Must be comfortable working independently in a remote setting.

• Knowledgeable about insurance carriers and medical necessity criteria is necessary.

• A commitment to patient-focused service is essential.

🏝️ Benefits

• No nights, weekends, or on-call shifts.

• Medical, Dental, and Vision Insurance offered.

• Options for HSA and FSA are available.

• Employee Assistance Program (EAP) provided.

• Basic Life Insurance and Long-Term Disability are included.

• 401(k) plan with an automatic 3% employer contribution plus up to 3% employer match.

• 17 days of Paid Time Off (PTO).

• 9 paid holidays each year.

• Annual automatic growth in compensation.

• Profit-sharing opportunities.

• Optional Pet Insurance, Legal, and ID Protection available.

• Training and equipment will be provided.