Cardiology Prior Authorization Pro

US Heart & Vascular; Houston (TX); On-site; USD 45,000 - 60,000; Full time

Job summary

US Heart and Vascular is seeking a Cardiology Prior Authorizations Specialist to join Willowbrook Cardiovascular Associates in Houston, TX. The role focuses on obtaining timely authorizations for Veins, Structural Heart and CT studies, ensuring eligibility checks, and coordinating with payers and clinical partners.

You will verify requirements, prepare medical necessity documentation, and support escalation to peer-to-peer reviews while delivering accurate compliance and patient communication.

Qualifications

• Familiarity with medical office procedures and billing practices.
• Proficient in clinical documentation review for insurance requirements.
• Compliance with regulatory guidelines (HIPAA, OSHA, fraud laws).
• High School diploma or equivalent required.
• Associate degree preferred in healthcare administration or business.
• 3-5 years in a similar healthcare authorization role.

Responsibilities

• Ensures timely and accurate insurance authorizations prior to services.
• Verifies insurance eligibility and benefits for identified services.
• Manages pre-certification, authorization, and referral requirements.
• Provides information to payers with medical records or letters of necessity.
• Escalates to peer-to-peer reviews when needed.
• Communicates with patients and staff to facilitate authorization.
• Prioritizes urgent cases and documents all applications.
• Follows policies if authorization is not obtained before service date.

Skills

Medical office procedures

Billing practices

Clinical documentation review

Regulatory compliance

ECW experience

Experience 3-5 years

Education

High School diploma or equivalent

Associate's degree in healthcare admin or business admin preferred

Tools

ECW (eClinicalWorks)

Job description

US Heart and Vascular is seeking a Cardiology Prior Authorizations Specialist to join Willowbrook Cardiovascular Associates in Houston, TX. The role focuses on obtaining timely authorizations for Veins, Structural Heart and CT studies, ensuring eligibility checks, and coordinating with payers and clinical partners.

You will verify requirements, prepare medical necessity documentation, and support escalation to peer-to-peer reviews while delivering accurate compliance and patient communication.