[Hiring] Prior Authorization Specialist @CardioOne

Role Description

We’re seeking an experienced, detail-oriented Prior-Authorization Specialist to join our team at CardioOne. You will be responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, and other services. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations. The specialist will collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals. You will report directly to the Associate Director of Revenue Cycle Management.

• Ensure timely and accurate insurance authorizations are in place prior to services being rendered.
• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
• Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services.
• Coordinates and supplies information to the review organization (payer) including medical record information and/or letter of medical necessity for determination of benefits.
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
• Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process.
• Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner.
• Completes accurate documentation in all applications.
• Follows departmental policies and procedures, when necessary, authorization is not obtained before the service date.
• Answers provider, staff, and patient questions surrounding insurance authorization requirements.
• Handles escalated authorization requests as needed.
• Provides team mentorship as needed.
• Other duties as assigned.

Qualifications

• Associate’s degree in healthcare administration or business administration preferred.
• A minimum of 3-5 years' experience in the same role, or related field in a healthcare setting is required.
• Familiarity with medical office procedures and billing practices.
• Cardiology experience preferred.
• Athena experience required.
• Proficient in clinical documentation review for alignment with insurance authorization requirements.
• Responsible for compliance with all regulatory requirements and/or guidelines, including OSHA, HIPAA, Federal Fraud and Abuse laws.

Requirements

• Remote: Colorado (Denver preferred), Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, Texas.

Benefits

• Full time position with an hourly range of $21.00-$27.00 dependent on years of relevant experience.
• This role will have medical, dental, and vision benefits along with a matching 401K.