INR Referral & Authorization Specialist | Englewood, CO
Reporting to Revenue Cycle Manager
This position requires 100% in-office in Englewood, Colorado.
Employment Type: Full Time
Radiology Imaging Associates (RIA) is comprised of over 100 radiologists. All with exceptional skill and expertise, most are fellowship-trained in their field of specialty for additional certification. We are dedicated to accurate and efficient patient diagnosis not matter what their condition. Our interventional radiologists perform some of the most leading-edge treatments available today. We partner with primary care physicians and hospitals across Colorado and Hawaii to provide a resource for both patients and physicians.
Primary Responsibilities
Referral Intake and Indexing
- Receive and review incoming referrals, orders, clinical records, imaging reports, demographic information, and insurance documentation.
- Index referral documents accurately into the appropriate patient record, referral platform, work queue, or document-management system.
- Confirm that referrals contain the information required for clinical review, scheduling, authorization, and billing.
- Identify incomplete or inconsistent information and promptly contact the referring office for clarification or missing documentation.
- Maintain accurate referral statuses and document all outreach, follow-up efforts, and outstanding requirements.
- Route referrals to the appropriate physician, advanced practice provider, clinical reviewer, scheduling team, or operational department.
- Monitor referral work queues and aging to prevent referrals from remaining unresolved.
Outgoing Referral Coordination
- Prepare and send referrals, orders, clinical records, imaging reports, and supporting documentation to outside providers and facilities.
- Confirm receipt of outgoing referrals when appropriate.
- Coordinate with outside organizations to determine referral requirements, scheduling processes, and documentation needs.
- Track outstanding outgoing referrals and follow up to support continuity of care.
- Communicate referral status and next steps to patients, referring offices, and internal clinical teams.
- Protect patient information and follow HIPAA and organizational privacy requirements when transmitting records.
Insurance Verification and Prior Authorization
- Verify patient insurance coverage, eligibility, benefits, network participation, and authorization requirements.
- Determine whether authorization, notification, predetermination, or referral approval is required before services are provided.
- Initiate and submit authorization requests through payer portals, telephone, fax, or other required methods.
- Gather and submit clinical documentation necessary to support medical-necessity review.
- Track pending authorization requests and follow up with payers until a determination is received.
- Accurately document authorization numbers, effective dates, approved services, units, service locations, servicing providers, and expiration dates.
- Confirm that the approved procedure, provider, facility, and date of service align with the scheduled service.
- Escalate urgent, delayed, denied, or administratively complex authorization cases to the appropriate clinical or RCM leader.
- Assist with peer-to-peer coordination, reconsideration requests, and authorization-related appeals by collecting and organizing required information.
- Communicate authorization status and unresolved financial-clearance issues to scheduling and clinical teams before the date of service.
Entry-Level Revenue Cycle Support
- Review patient accounts for demographic, registration, insurance, authorization, and referral-related errors.
- Correct or route identified account issues to the appropriate department.
- Assist with claim-status research and basic payer follow-up.
- Review authorization-related claim edits, denials, and requests for additional information.
- Compare claim information with the authorization to identify discrepancies involving procedure codes, units, dates, providers, or places of service.
- Obtain and submit missing authorization documentation when permitted.
- Support denial-prevention efforts by identifying recurring referral, registration, documentation, or authorization issues.
- Document account activity clearly and consistently within the billing or practice-management system.
- Assist with work queues, reports, audits, and special RCM projects as assigned.
- Refer coding, clinical, compliance, payment-posting, and complex denial issues to the appropriate subject-matter expert.
Communication and Service
- Serve as a responsive point of contact for patients, referring offices, outside facilities, payers, and internal departments.
- Explain referral and authorization requirements in a professional and patient-friendly manner.
- Provide timely updates regarding missing information, authorization delays, scheduling barriers, and next steps.
- Maintain positive working relationships with physicians, clinical staff, scheduling teams, payer representatives, and outside organizations.
- Escalate concerns that may delay care, create financial risk, or negatively affect the patient experience.
Performance Expectations
The INR Referral & Authorization Specialist will be expected to:
- Process referrals and authorization requests accurately and within established turnaround times.
- Maintain complete and timely documentation of all account and referral activity.
- Proactively identify missing information before the scheduled date of service.
- Minimize preventable authorization denials and scheduling delays.
- Maintain manageable referral and authorization work-queue aging.
- Respond to patient and provider inquiries within departmental service standards.
- Consistently follow payer, HIPAA, compliance, and organizational requirements.
- Escalate clinical, financial, and operational risks appropriately.
Minimum Qualifications
- High school diploma or equivalent.
- At least one year of experience in a medical office, patient-access, referral, insurance-verification, prior-authorization, scheduling, billing, or revenue-cycle environment.
- Basic understanding of health insurance terminology, including eligibility, benefits, deductibles, copayments, coinsurance, referrals, prior authorization, and medical necessity.
- Experience working with electronic health records, practice-management systems, payer portals, or document-imaging systems.
- Strong data-entry, organizational, communication, and follow-up skills.
- Ability to manage multiple work queues, deadlines, and competing priorities.
- Ability to communicate professionally with patients, physicians, payer representatives, and outside provider offices.
- Ability to handle protected health information confidentially.
Preferred Qualifications
- Two or more years of referral, prior-authorization, patient-access, or revenue-cycle experience.
- Experience supporting interventional radiology, neuroradiology, neurology, neurosurgery, vascular services, hospital-based procedures, or another procedural specialty.
- Familiarity with Medicare, Medicaid, commercial insurance, and managed-care requirements.
- Experience reviewing CPT codes, diagnosis codes, authorization requirements, and medical-necessity documentation.
- Experience researching authorization-related denials or claim edits.
- Knowledge of payer portals and electronic referral-management systems.
- Medical terminology training or certification.
- Certified Revenue Cycle Representative, Certified Medical Administrative Assistant, Certified Professional Biller, or similar credential.
Core Competencies
- Accuracy and attention to detail
- Ownership and accountability
- Time management and prioritization
- Critical thinking and problem solving
- Professional written and verbal communication
- Patient-service orientation
- Persistence with payer and provider follow-up
- Ability to recognize and escalate risk
- Collaboration across clinical, operational, and RCM teams
- Adaptability in a changing environment
Work Environment
This position operates in a professional healthcare and revenue-cycle environment. The employee regularly works with patient records, payer websites, telephone systems, electronic work queues, and multiple software applications. The position requires prolonged computer use and frequent communication by telephone, email, and electronic messaging.
Compensation is between $21 and $24 per hour
In accordance with Colorado law, the range provided is Radiology Imaging Associates' reasonable estimate of the base compensation for this role, and is based on non-discriminatory factors such as experience, knowledge, skills, and abilities. This position will receive applications on an ongoing basis and will remain open until filled.
Our benefits include:
Medical, dental, and vision insurance
Term life insurance, AD&D, and EAP
Long Term Disability
Generous Paid Time Off
Paid holidays
Voluntary income protection options (ie. supplemental life insurance, accident, critical illness)
Profit-sharing 401(k) retirement plan
Tuition reimbursement
Full-time employees will become eligible for benefits on the 1st day of the month following 30 days of employment. Part-time employees may have access to some of these benefits, which may be on a pro-rated basis. PRN employees are not eligible for benefits