Cardiology Prior Authorization Expert

US Heart and Vascular; Houston (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

US Heart and Vascular seeks a dedicated Prior Authorization Specialist for our Willowbrook Cardiovascular Associates team in Houston, TX. This full-time day-shift role focuses on obtaining prior authorizations for procedures and services, verifying insurance coverage, and coordinating with payers.

You will collaborate with clinicians and financial counselors, review medical records as needed, and ensure timely submissions while adhering to HIPAA and regulatory guidelines.

Qualifications

• Familiarity with medical office procedures and billing practices.
• Proficient in clinical documentation review for alignment with insurance authorization requirements.
• Responsible for compliance with all regulatory requirements and/or guidelines (OSHA, HIPAA, Federal Fraud and Abuse laws).
• High School Diploma or equivalent required.
• 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.
• ECW experience is preferred.

Responsibilities

• Ensures 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.
• Works other departmental tasks as needed.

Skills

Medical office procedures

Clinical documentation review

Regulatory compliance

HIPAA compliance

Education

High School Diploma or GED

Associate’s degree in healthcare administration or business administration preferred

Tools

ECW experience

Job description

US Heart and Vascular seeks a dedicated Prior Authorization Specialist for our Willowbrook Cardiovascular Associates team in Houston, TX. This full-time day-shift role focuses on obtaining prior authorizations for procedures and services, verifying insurance coverage, and coordinating with payers.

You will collaborate with clinicians and financial counselors, review medical records as needed, and ensure timely submissions while adhering to HIPAA and regulatory guidelines.