Pre-Authorization Specialist

Vital Heart & Vein; Houston (TX); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

Competitive pay

Benefits package

Team environment

Growth opportunities

Exposure to RCM

Job summary

Vital Heart & Vein is seeking a dedicated Pre-Authorization Specialist to join our Revenue Cycle Management team in Houston. You will manage prior authorizations for diagnostic imaging and related tests, ensuring timely, complete submissions and reducing denials.

Ideal candidates have at least 2 years of prior authorization experience in healthcare, with strong knowledge of Availity, eClinicalWorks, and payer requirements.

Qualifications

• Minimum 2 years in prior authorization or insurance verification in a healthcare setting.
• Experience obtaining authorizations for diagnostic imaging and testing - MRI, PET, CT, sleep studies, and related services - required.
• Proficiency with eClinicalWorks required.
• Strong knowledge of Availity and major payer portals - UHC, BCBS, Aetna, Ambetter, Cigna, Humana, Medicare Advantage.
• Understanding of payer authorization timelines - routine vs urgent vs emergent.
• Strong organizational skills with ability to manage a high-volume authorization queue.

Responsibilities

• Initiate and submit prior authorization requests for diagnostic testing services including MRI, PET scans, CT scans, sleep studies, nuclear imaging, echocardiograms, stress testing, Holter monitoring, and vascular studies.
• Verify authorization requirements by payer, plan type, and CPT code prior to scheduling.
• Review clinical documentation and physician orders to ensure all required clinical information is included with each authorization request.
• Submit authorization requests through Availity, payer portals, and phone - selecting the most efficient channel per payer.
• Monitor authorization status daily and follow up on all pending, deferred, or unresponsive requests within 24-48 hours.
• Enter approved authorization numbers into eClinicalWorks, including authorized CPT codes, effective dates, expiration dates, and number of authorized visits.
• Communicate authorization status to scheduling, clinical, and billing teams in a timely manner.
• Identify and elevate authorization denials to supervisor for peer-to-peer review or appeal.
• Request retroactive authorizations when applicable and within payer guidelines.
• Maintain accurate and complete documentation of all authorization activity in eCW.
• Stay current on payer-specific authorization requirements - including LCD/NCD medical necessity criteria for each test type.
• Collaborate with providers and clinical staff to ensure documentation supports medical necessity for all requested services.
• Assist with appeal submissions when authorizations are denied - including preparation of medical necessity letters and supporting clinical documentation.

Skills

Payer expertise

Organizational skills

Attention to detail

Communication skills

Tools

eClinicalWorks

Availity

Job description

Founded in 1998, Vital Heart & Vein is the largest private cardiology practice in the Houston area. Our 40+ board-certified physicians specialize in cardiovascular disease, interventional cardiology, vascular and endovascular surgery, advanced heart failure, and podiatry. We provide advanced diagnostic testing and comprehensive therapies for coronary, electrophysiology, vascular, and vein diseases across Greater Houston, including Humble, Pearland, West Houston, Beaumont, Northwest Houston, and the Texas Medical Center.

We are seeking a dedicated and detail-oriented Pre-Authorization Specialist to join our Revenue Cycle Management team. This role is responsible for obtaining timely and accurate prior authorizations for diagnostic imaging and testing services - including MRI, PET scans, CT scans, sleep studies, and related cardiology and vascular diagnostics. The ideal candidate is highly organized, payer-savvy, and understands the clinical and administrative requirements needed to secure authorization and prevent denials before they occur.

KEY RESPONSIBILITIES

• Initiate and submit prior authorization requests for diagnostic testing services including MRI, PET scans, CT scans, sleep studies, nuclear imaging, echocardiograms, stress testing, Holter monitoring, and vascular studies
• Verify authorization requirements by payer, plan type, and CPT code prior to scheduling
• Review clinical documentation and physician orders to ensure all required clinical information is included with each authorization request
• Submit authorization requests through Availity, payer portals, and phone - selecting the most efficient channel per payer
• Monitor authorization status daily and follow up on all pending, deferred, or unresponsive requests within 24-48 hours
• Enter approved authorization numbers into eClinicalWorks, including authorized CPT codes, effective dates, expiration dates, and number of authorized visits
• Communicate authorization status to scheduling, clinical, and billing teams in a timely manner
• Identify and elevate authorization denials to supervisor for peer-to-peer review or appeal
• Request retroactive authorizations when applicable and within payer guidelines
• Maintain accurate and complete documentation of all authorization activity in eCW
• Stay current on payer-specific authorization requirements - including LCD/NCD medical necessity criteria for each test type
• Collaborate with providers and clinical staff to ensure documentation supports medical necessity for all requested services
• Assist with appeal submissions when authorizations are denied - including preparation of medical necessity letters and supporting clinical documentation

REQUIRED QUALIFICATIONS

• Minimum 2 years of experience in prior authorization or insurance verification in a healthcare setting
• Experience obtaining authorizations for diagnostic imaging and testing - MRI, PET, CT, sleep studies, and related services - required
• Proficiency with eClinicalWorks required
• Strong knowledge of Availity and major payer portals - UHC, BCBS, Aetna, Ambetter, Cigna, Humana, Medicare Advantage
• Understanding of payer authorization timelines - routine vs urgent vs emergent
• Strong organizational skills with ability to manage a high-volume authorization queue

WHAT WE OFFER

• Competitive compensation based on experience
• Comprehensive benefits package- medical, dental, vision, and paid time off
• Collaborative and supportive team environment
• Opportunity for growth within a fast-growing cardiology and vascular specialty practice
• Exposure to a full-service revenue cycle operation across multiple service lines and locations