Remote Cardiology Prior Authorization Specialist

CardioOne; Muncie (IN); Remote; USD 29,000 - 37,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401K matching

Job summary

CardioOne is seeking an experienced Prior-Authorization Specialist to obtain and verify authorizations for procedures and tests, ensuring compliance with insurance policies and healthcare regulations. You will report directly to the Associate Director of Revenue Cycle Management and collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals.

This remote-friendly role requires 3-5 years in a similar position, familiarity with medical office

Qualifications

• Associate's degree in healthcare administration or business administration preferred.
• 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.
• Compliance with OSHA, HIPAA, Federal Fraud and Abuse laws.

Responsibilities

• Ensure timely and accurate insurance authorizations are in place prior to services.
• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services.
• 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.

Skills

Attention to detail

Communication skills

Medical office procedures

Clinical documentation review

Education

Associate's degree in healthcare administration or business administration

Tools

Athena experience

Job description

CardioOne is seeking an experienced Prior-Authorization Specialist to obtain and verify authorizations for procedures and tests, ensuring compliance with insurance policies and healthcare regulations. You will report directly to the Associate Director of Revenue Cycle Management and collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals.

This remote-friendly role requires 3-5 years in a similar position, familiarity with medical office