Authorization & Account Verification Specialist

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Mission: Advanced Radiology Consultants is committed to building and maintaining the trust of our referring physicians and providing our patients with exceptional care.

Advanced Radiology is one of the largest independent radiology practices in the tri‑state area. We look for team members who want to grow and be professionally challenged while enjoying a rewarding, caring, and friendly environment. We are hiring an Authorization & Account Verification Specialist. The pay range for this role will depend on experience and qualifications.

Schedule: Monday – Friday, 8:30 am – 5:00 pm

Position Summary: An Authorization & Account Verification Specialist reviews radiology orders to verify demographic information, insurance eligibility, prior‑authorization requirements, and initiates or verifies authorization for requested examination CPT codes when applicable by insurance, third‑party liability or other and follows medical policies. Complete and accurate data entry into the patient’s account is required.

Essential

Job Duties and Responsibilities:

• Review requested radiology order for patient demographic data, insurance/billing information, requested CPT and clinical information.
• Ensure all patient demographic and insurance information is current and accurate by updating demographic data and insurance coverage, real‑time eligibility, commercial insurance or third‑party websites, and telephone verification as needed.
• Verify prior‑authorization requirements for requested CPT by covering carrier.
• Obtain pre‑authorizations on high‑modality imaging requests by conducting a thorough review of all documentation submitted to support diagnostic imaging procedure, including script review from referring physician and detailed review of EMR and/or clinical information.
• Enter detailed notes regarding communication with insurance carriers and/or health‑care providers and steps taken in the authorization process.
• Verify referring office provided prior‑authorization by patient, date of birth, referring provider, CPT and rendering company and/or location.
• Accurate and timely communication with needed staff on authorization issues.
• Communicate regularly with insurance companies, health‑care providers, internal scheduling department, front desk coordinators and clinical staff at sites on any exams that require clinical review and/or denials from insurance carriers.
• Respond to telephone, electronic and in‑person inquiries and complaints.
• Thorough review of scheduled CT, MR, NM, PET, Doppler US patients to ensure accurate and timely receipt of demographic, insurance and clinical information required for the patient’s examination.
• Maintain positive relations and interactions with insurance companies, referring offices, patients and internal ARC staff.
• Demonstrate initiative in problem solving and resolving customer satisfaction issues.
• Audit own work to ensure quality and report safety or quality events.
• Attend meetings, training, learning and development sessions as required.
• Respect patient confidentiality by adhering to HIPAA standards.

Knowledge, Skills and Abilities:

• Ability to multi‑task and function in a fast‑paced environment.
• Customer service skills – empathetic, active listener, strong follow‑through skills.
• Proficient computer and data entry skills.
• Basic knowledge of anatomy and medical terminology preferred.
• Listen to feedback or constructive criticism from management and apply it to self.
• Critical thinking – the ability to think creatively, problem solve and work independently.
• Knowledge of ICD‑10 and CPT codes.
• Comfortable utilizing de‑escalation skills when communicating with patients and physician offices in crisis.

Educational Requirements:

• High school diploma or GED.
• Knowledge and understanding of health insurance carrier eligibility and authorization processes.
• 1‑2 years related experience in a healthcare office setting, preferably in radiology.

Core Competencies:

• Customer Service – Manages difficult or emotional customer situations; responds promptly to customer needs; responds to requests for service and assistance.
• Interperson…