Prior Authorization Specialist (3176)

US Heart & Vascular; Houston, Northern (TX, KY); Hybrid; USD 42,000 - 62,000; Full time

Job summary

US Heart and Vascular in Houston, TX is seeking a Cardiology Prior Authorizations Specialist to join Willowbrook Cardiovascular Associates. You will manage prior authorizations for veins, structural heart and CT studies.

The role requires a high school diploma, 3–5 years' experience in medical billing/authorizations, and familiarity with OSHA/HIPAA rules, with ECW experience preferred. Day shift, full-time position.

Qualifications

• Familiar with medical office procedures and billing practices.
• Proficient in clinical documentation review for insurance authorizations.
• Ensure compliance with OSHA, HIPAA and Fraud & Abuse laws.
• High School Diploma or GED required; an Associate’s degree preferred.
• 3–5 years of experience in a similar healthcare role.
• ECW experience is preferred.

Responsibilities

• Ensure timely and accurate insurance authorizations before services.
• Verify insurance eligibility and benefits for identified services.
• Handle pre-certification, authorization, and referral requirements.
• Coordinate and provide information to payers including medical records when needed.
• Collaborate with clinical staff for escalations to peer-to-peer review.
• Communicate with patients and staff to facilitate authorization processes.
• Prioritize urgent cases and document all applications.
• Follow policies if authorization is not obtained before service date.
• Address questions about authorization requirements from providers, staff, and patients.
• Handle escalated authorization requests and mentor team.

Skills

Medical office procedures

Billing practices

HIPAA compliance

Documentation review

Regulatory compliance

Communication

Clinical coordination

Education

High School Diploma or GED

Associate’s degree in healthcare administration or business administration

Tools

ECW

Job description

Job Details

Job Location: Willowbrook - Dotson - Houston, TX 77070

Position Type: Full Time

Education Level: High School Diploma/GED

Travel Percentage: None

Job Shift: Day

Job Category: Other Positions

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 team

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.

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.

Qualifications