Authorization & Account Verification Specialist

Position Summary

The Authorization & Verification Specialist is responsible for reviewing radiology exam orders to ensure patient information is accurate and complete. This role verifies patient demographics, insurance eligibility, and authorization requirements for imaging exams. The specialist works closely with insurance companies, provider offices, and internal teams to obtain or confirm approvals and ensure all information is correctly entered into the patient’s account.

Essential Job Duties and Responsibilities

• Review provider orders/referrals for demographic, insurance, CPT, and clinical documentation for accuracy
• Verify insurance eligibility, benefits, and prior authorization requirements
• Initiate, track, and validate prior authorizations by payor guidelines
• Confirm accuracy of authorizations received from referring offices
• Document authorization activity and communications accurately in the patient record
• Communicate authorization status, issues, and denials to providers, staff, payers, and patients
• Ensure compliance with payer policies, timelines, and HIPAA regulations
• Demonstrate problem-solving skills
• Participate in required meetings, training, and professional development sessions
• Adhere to RVS policies, procedures and documented workflow

Knowledge, Skills, and Abilities

• Multitasks effectively in a fast-paced office
• Patient-focused customer service and communication skills
• Accurate data entry and strong computer proficiency
• Working knowledge of medical terminology, ICD-10, and CPT
• Problem-solving with ability to accept coaching
• De-escalate patient and provider concerns

Education and Experience Requirements

• High school diploma or GED required
• Knowledge of insurance eligibility, benefits, and prior authorization processes
• 1–3 years of healthcare administrative experience preferred
• EPIC or similar EMR experience preferred

Competencies

• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Responds to requests for service and assistance.
• Interpersonal Skills - Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control.
• Oral Communication - Listens and gets clarification; Responds well to questions.
• Teamwork - Contributes to building a positive team spirit.
• Ethics - Treats people with respect; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
• Organizational Support - Follows policies and procedures.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Monitors own work to ensure quality.
• Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions; Uses equipment and materials properly.
• Adaptability - Adapts to changes in the work environment; Able to deal with frequent changes, delays, or unexpected events.
• Attendance/Punctuality - Is consistently at work and on time.

Physical Demands/Working Conditions

Work is performed in a business office environment. Work is primarily stationary, requires sitting or standing for long periods of time; Manual dexterity and eye-hand coordination are sufficient to operate a keyboard and other office equipment is required.

Company Information

• Work Smart, Live Well: The success of Advanced Radiology is earned every day through our dedication to quality patient care and continual improvement of the patient experience.
• Health Benefits: Medical and Prescription Drug Coverage, Dental Coverage, Vision Coverage, Health Savings Account (HSA) with Matching Employer Contribution, Annual Profit-Sharing Plan Contribution, Paid Opt-Out Benefit Option, Basic Life and Accident Insurance.
• Additional Benefits: Generous Paid Time Off (PTO), 401(k) Plan with Employer Contribution.
• Equal Opportunity Employer.