Prior Authorization Specialist

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 in need of a Cardiology Prior Authorizations Specialist to join our team at Willowbrook Cardiovascular Associates in Houston, TX.If you have a passion for obtaining prior authorizations for Veins, Structural Heart and CT Studies, please join our US Heart and Vascular teamResponsibilities:• 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.Requirements:• 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. These requirements/guidelines include, but are not limited to: 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.About Houston, TX:Houston is a diverse city with a booming job market in energy, healthcare, and tech. It has no state income tax, an affordable cost of living, and world-class dining and entertainment. Green spaces, museums, and pro sports teams add to its appeal. Whether for career growth or culture, Houston has it all.