Remote Prior Authorization Specialist (Cardiology)

CardioOne; Philadelphia (Philadelphia County); Remote; USD 29,000 - 37,000; Full time

Job summary

CardioOne is seeking an experienced Prior-Authorization Specialist to obtain and verify authorizations for procedures, tests, and services. You will ensure timely approvals while complying with insurer policies and healthcare regulations, collaborating with providers, patients, and insurance representatives.

You will report to the Associate Director of Revenue Cycle Management and contribute to accurate documentation, eligibility checks, and escalation to peer-to-peer review as needed.

Qualifications

• 3–5 years in prior authorizations or related healthcare role
• Familiar with medical office procedures and billing practices
• Cardiology experience preferred
• Athena experience required
• Proficient in clinical documentation review for insurance authorizations
• Compliance with OSHA, HIPAA, and fraud and abuse laws

Responsibilities

• Obtain and verify timely prior authorizations before services
• Verify insurance eligibility and benefits for identified services
• Check pre-certification, authorization, and referral requirements
• Provide payer with medical records and letters of necessity when needed
• Escalate to peer-to-peer review as required
• Communicate with patients and providers to facilitate authorization
• Prioritize urgent cases and document all applications
• Follow policies if authorization not obtained before service date
• Answer questions about authorization requirements
• Handle escalated authorization requests
• Mentor teammates as needed
• Perform other duties as assigned

Skills

Medical office procedures

Billing practices

Cardiology experience

Athena experience

Clinical documentation review

Education

Associate degree (healthcare administration or business)

Job description

CardioOne is seeking an experienced Prior-Authorization Specialist to obtain and verify authorizations for procedures, tests, and services. You will ensure timely approvals while complying with insurer policies and healthcare regulations, collaborating with providers, patients, and insurance representatives.

You will report to the Associate Director of Revenue Cycle Management and contribute to accurate documentation, eligibility checks, and escalation to peer-to-peer review as needed.