Prior Authorization Specialist
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Job Description
Prior Authorization Specialist securing imaging authorizations for TRA Medical Imaging, a physician-led radiology practice. Verifying insurance, coding, medical necessity, and HIPAA compliance remotely.
Responsibilities:
- Obtain prior authorizations for imaging procedures including MRI, CT, PET, Nuclear Medicine, Fluoroscopy, Interventional Radiology, Mammography, Ultrasound, X-ray, and Bone Densitometry
- Verify insurance eligibility, benefits, and authorization requirements
- Ensure correct CPT and ICD-10 coding for all scheduled exams
- Contact referring physician offices and insurance carriers to obtain required documentation
- Review medical records to confirm medical necessity
- Enter authorization numbers and detailed documentation into the RIS system
- Educate patients on insurance and authorization requirements
- Reschedule patients when authorization is pending
- Provide price quotes and explain financial assistance options
- Maintain HIPAA compliance and patient confidentiality
- Collaborate with technologists, front desk staff, and scheduling teams to ensure exam accuracy
- Ensure scheduled imaging examinations are authorized for the correct facility, meet medical necessity guidelines, and comply with insurance carrier and HIPAA requirements
- Work under established guidelines and immediate supervision within Health Information Management, Patient Access, and Scheduling functions
Requirements:
- Applicants must reside in Alabama, Arizona, Georgia, Idaho, North Carolina, Texas, Utah, or Washington
- High School Diploma or GED
- Formal medical terminology training or equivalent medical office experience
- Minimum 3 years of medical office insurance authorization experience
- Knowledge of CPT and ICD-10 coding
- Experience navigating insurance websites for eligibility and claim status
- Understanding of radiology procedures and authorization workflows
- Strong attention to detail and ability to manage multiple tasks
- Effective written and verbal communication skills
- Professional customer service skills
- Clinical experience in a radiology or imaging setting preferred
- Experience working with RIS systems preferred
- Experience with PET scan authorization processes preferred
- Knowledge of HCPCS coding preferred
- Ability to work Monday through Friday, 9:00 AM–5:30 PM Pacific Time
- Comfortable working independently in a remote environment
- Knowledgeable about insurance carriers and medical necessity criteria
- Committed to patient-focused service
Benefits:
- No nights, weekends, or on-call shifts
- Medical, Dental, and Vision Insurance
- HSA and FSA options
- Employee Assistance Program (EAP)
- Basic Life Insurance and Long-Term Disability
- 401(k) with automatic 3% employer contribution plus up to 3% employer match
- 17 days of PTO
- 9 paid holidays
- Annual automatic compensation growth path
- Profit sharing
- Optional Pet Insurance, Legal, and ID Protection
- Training and equipment provided
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