PRE-AUTHORIZATION SPECIALIST - DIAGNOSTIC IMAGING

About the Practice

Tri-State Orthopaedics & Sports Medicine is an independent, well-respected, and busy orthopaedic group celebrating 50 years of providing the Pittsburgh region with advanced orthopaedic care for a variety of conditions and injuries. As we prepare for the future, we are expanding our team.

Responsibilities

• Review clinical notes for required content, verify insurance benefits, submit requests through payer portals, and track statuses to prevent delays in care and/or denied claims.
• Complete and process prior insurance authorizations for MRI/CT scans for all providers in the practice.
• Proactively monitor, track pending imaging requests, and provide necessary information to insurance companies for approval, addressing problems/concerns before they impact patient care.
• Obtain and schedule STAT/URGENT imaging prior authorizations for necessary exams.
• Assist and communicate authorization status with providers, imaging facilities, clinical staff, and patients.
• Facilitate peer-to-peer conversations, reviews, or appeals for denied authorizations with insurance companies and providers, and address inquiries from providers, staff, and patients.
• Remain current with payer guidelines and authorization requirements.
• Return patient and imaging facility phone calls and email correspondence in a timely manner; answer basic imaging prior authorization-related questions regarding the process.
• Maintain confidentiality and comply with HIPAA regulations.

Requirements

• Strong telephone and computer skills.
• Ability to provide exceptional customer service with a positive and upbeat attitude in a fast-paced practice environment.
• Understanding of basic medical terminology and medical office experience.

Qualifications

• High school diploma or equivalent; associate degree or medical certification is a plus.
• One to two years of experience in medical billing, insurance verification, or prior authorizations.
• Knowledge of CPT and ICD-10 medical coding.
• Familiarity with medical terminology for radiology and advanced imaging is a plus.
• Strong computer literacy and experience with electronic health record (EHR) systems.