Prior Authorization Specialist – US Healthcare / Radiology

About the Opportunity

Intugo, in partnership with a foreign company specializing in diagnostic imaging services, is looking for an experienced Prior Authorization Specialist to join its healthcare operations team.

This position is adecuado for professionals with a strong background in US healthcare insurance, medical prior authorizations, eligibility verification, and communication with insurance providers.

The selected candidate will be responsible for managing the authorization process for diagnostic imaging procedures, ensuring that patients receive the necessary insurance approvals before their scheduled appointments.

We are looking for someone who is detail-oriented, organized, persistent, and comfortable working directly with US insurance companies, healthcare providers, and medical offices.

Key Responsibilities

Insurance Eligibility & Benefits Verification

- Verify active insurance coverage, eligibility, plan benefits, and network participation.
- Determine whether medical imaging procedures require prior authorization, referrals, or additional documentation.
- Verify deductibles, copayments, coinsurance, and patient financial responsibility.
- Work with commercial insurance, Medicare, Medicare Advantage, Medicaid managed care, workers' compensation, and no-fault insurance.

Prior Authorization Processing

- Submit and manage prior authorization requests for diagnostic imaging procedures, including MRI, CT scans, PET/CT, and other imaging services.
- Use insurance portals, radiology benefit manager platforms, phone calls, and fax submissions to process requests.
- Review medical orders and clinical documentation to ensure authorization requirements are met.
- Work with CPT codes, ICD-10 diagnosis codes, physician information, and supporting medical records.
- Follow up on pending authorizations to ensure approvals are received before scheduled appointments.
- Verify authorization numbers, approved procedures, effective dates,



and insurance requirements.

Denials, Appeals & Follow-Up

- Identify reasons for denied or delayed authorizations.
- Coordinate corrected submissions, additional documentation requests, and appeals when necessary.
- Assist in scheduling peer-to-peer reviews between physicians and insurance representatives.
- Communicate with referring physicians, insurance companies, and internal scheduling teams regarding authorization status.
- Maintain accurate documentation of authorization requests, insurance communications, and case resolutions.

Administrative & Healthcare Coordination

- Update patient records and authorization information in medical systems.
- Prioritize urgent cases and upcoming appointments.
- Coordinate with scheduling and billing teams to minimize delays and prevent insurance-related claim denials.
- Follow HIPAA regulations and maintain strict patient confidentiality.

Required Qualifications
- Minimum 2 years of experience in medical prior authorizations, insurance verification, or related US healthcare insurance operations.
- Hands-on experience submitting and following up on prior authorization requests.
- Strong understanding of US healthcare insurance plans and coverage requirements.
- Experience using insurance payer portals and at least one radiology benefit manager platform, such as eviCore, Carelon, or Evolent (NIA).
- Familiarity with CPT and ICD-10 coding used in medical procedures.
- Ability to review medical orders, physician notes, and supporting clinical documentation.
- Experience working with medical software such as RIS, EHR, or practice management systems.




- Fluent spoken and written English, with clear communication skills for interactions with US insurance representatives and medical offices.
- Strong organizational skills, attention to detail, and ability to manage multiple authorization requests simultaneously.
- High school diploma or equivalent.

Additional Valuable Experience
- Previous experience working with radiology centers, diagnostic imaging services, or specialty medical practices.
- Knowledge of authorization requirements for MRI, CT scans, PET/CT, and other imaging procedures.
- Experience handling insurance denials, appeals, and peer-to-peer reviews.
- Familiarity with workers' compensation, no-fault claims, and medical lien cases.
- Experience communicating directly with physician offices to obtain clinical documentation.

Compensation & Benefits:

- Bi-Weekly payments
- $1000 MXN monthly food vouchers
- 4% savings fund
- Private Medical Insurance
- Full legal benefits (vacation, IMSS, profit sharing, etc.)

Work Location: On-site, Hermosillo, Sonora.

Important Note for Applicants

This is a specialized healthcare position that requires previous hands-on experience with US medical insurance and prior authorization processes.

Candidates are strongly encouraged to apply only if they meet most of the qualifications and experience requirements listed above, particularly those related to insurance verification, prior authorization submissions, payer portals, medical documentation, and US healthcare insurance procedures.

While direct experience in radiology is highly valuable, applicants with substantial experience in prior authorizations for other US medical specialties may also be considered.

Please note that general customer service or medical appointment scheduling experience alone is not sufficient for this position. Prior authorization and insurance-related experience are essential.

Sueldo: A partir de $24,000.00 al mes

Lugar de trabajo: Empleo presencial

📌 Prior Authorization Specialist (Hermosillo)
🏢 Intugo
📍 Hermosillo