Authorization Specialist

This position will transition to a hybrid role once the employee is fully trained and receives management approval. Training will be completed on-site at our corporate office in Warwick, RI. Monday-Friday 9:30 AM-6:00 PM.

SUMMARY:

Responsible for obtaining prior authorizations, verifying insurance, and the collection of selected accounts for Rhode Island Medical Imaging. This position also assists patients with questions regarding coverage and payment issues and serves as a key component of the cash flow for the institution.

SCHEDULE:

• Monday-Friday 9:30 AM-6:00 PM

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Obtain prior authorizations from insurance companies for selected exams and document accordingly within the company system.
• Obtain insurance verifications and out of pocket expenses for patients prior to their exams.
• Communicate out of pocket expenses to the patient and note accounts accordingly.
• Assist patients with questions regarding their benefits and out of pocket expenses in an efficient and professional manner.
• Work daily eligibility reports for hospital sites to verify insurance information.
• Effectively utilize billing and scheduling software to ensure efficient workflow.
• Understand the elements associated with completing the HCFA 1500 billing form for payor(s). Understand and resource billing guidelines for each payor; stay informed on related changes.
• Utilize CPT codes, HCPC codes, and ICD-10 codes in daily workflow. Use department and payor resources to ensure that accounts are accurate and complete.
• Take initiative and alert Management to possible issues or concerns.
• Crosstrain and fill in for other team members when directed by Management.
• As needed, enlist the help of the Supervisor to ensure that accounts remain collectable.
• Stay informed on insurance changes regarding policy and coverage guidelines.
• Maintain professionalism at all times and adhere to all company policies and procedures.
• Consistently apply the corporate values of respect, honesty, fairness, and constant pursuit of excellence in improving local patient health status through the provision of customer-friendly, geographically accessible, and high-value services within the environment of a diagnostic imaging company.
• Ensure that all interactions are in compliance with HIPAA and federal compliance regulations.
• Participate in meetings as requested.
• Perform other duties as assigned.

BASIC KNOWLEDGE/SKILLS:

• Must have knowledge of third-party billing requirements.
• Ability to maintain sensitivity to the delicate nature of collecting payments for medical services while remaining effective in securing those payments.
• Ability to adapt, in a timely manner, to changes in collection rules as defined by State and/or Federal law and/or Management.
• Ability to work in a team environment.
• Must be able to make decisions and manage/prioritize workloads.
• Must have excellent telephone and interpersonal skills.
• Bilingual is a plus.

EDUCATION:

• High school diploma or equivalent.
• Additional courses in insurance billing, computer basics, and medical terminology preferred.

EXPERIENCE:

• One year of Prior Authorization experience preferred.

PHYSICAL DEMANDS:

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. This description is not intended to be a complete statement of the position, but rather to act as a guide to the general work to be performed. The requirements are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual's competencies and customer requirements impact the actual role performed. Prolonged periods of repetitive sitting and standing at a desk and working on a computer. Must be able to perform all essential duties without restriction.

Join an award-winning organization! With numerous private, state-of-the-art medical diagnostic imaging facilities, join the team that has been providing Rhode Island with imaging excellence for over 80 years! The American College of Radiology has named RIMI one of the first outpatient diagnostic imaging Centers of Excellence in the country and the first in Rhode Island. RIMI also has the honor of being named an eight-time winner of Providence Business News' Healthiest Employers of Rhode Island Award, most recently in 2025!

RIMI offers best-in-class benefits to eligible employees including multi-tiered health plans, flexible spending accounts, generous paid time off, 401(k) plan with profit sharing component, uniform reimbursement, company "swag," yearly reimbursement for continuing medical education, educational assistance (reimbursement) program, student loan repayment program, and career development opportunities. Enjoy competitive pay and all in our innovative culture that consistently provides the highest levels of quality, safety, technology, and patient care.