Prior Authorization Specialist

CardioOne; United States; Remoto; USD 29.000 - 37.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, and vision benefits

401K matching

Descrizione del lavoro

CardioOne is seeking a detail-oriented Prior-Authorization Specialist to obtain and verify authorizations for procedures, tests, and services. You will collaborate with providers, patients, and payers, ensuring timely approvals and accurate documentation under HIPAA and related regulations.

Remote-friendly role with Colorado, Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, and Texas locations considered. 21.00–27.00 USD hourly, full-time, with benefits including 401(k) matching.

Competenze

• Associate’s degree in healthcare administration or business administration preferred.
• 3–5 years' experience in prior-authorization or related healthcare role.
• 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.
• Compliance with regulatory requirements (OSHA, HIPAA, fraud and abuse laws).

Mansioni

• Ensure timely and accurate insurance authorizations are in place prior to services.
• Verify insurance eligibility and benefits to ensure adequate coverage.
• Identify and confirm pre-certification, authorization, and referral requirements.
• Provide patient, provider, and payer information for review organizations as needed.
• Collaborate with clinical staff on escalated authorization reviews.
• Communicate with patients and staff to facilitate the authorization process.
• Prioritize workload to handle urgent cases promptly.
• Document thoroughly in all systems and applications.
• Follow policies if authorization is not obtained before service date.
• Address questions about authorization requirements from providers and staff.
• Handle escalated authorization requests and mentor teammates.
• Perform additional duties as assigned.

Conoscenze

Regulatory compliance

Insurance verification

Clinical documentation review

Attention to detail

Formazione

Associate’s degree in healthcare administration or business administration

Strumenti

Athena experience

Descrizione del lavoro

About the Job

We are 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.

What you’ll do:

• 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.

What you’ll need:

• 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. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws.

Work Location:

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

Additional Information

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.