Remote Prior Authorization Specialist – Cardiology

CardioOne; United States; Remote; USD 29,000 - 37,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

Matching 401K

Job summary

CardioOne is seeking an experienced Prior-Authorization Specialist to join our remote team. You will obtain and verify prior authorizations for procedures, diagnostics, and other services, ensuring timely, policy-compliant approvals.

You will collaborate with providers, patients, and insurers, maintain accurate documentation, and escalate when needed. Reporting to the Associate Director of Revenue Cycle Management, you will help sustain clean, efficient authorization workflows.

Qualifications

• Associate degree in healthcare administration or business administration preferred.
• Minimum 3–5 years of experience in a similar role in a healthcare setting.
• 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 and Federal Fraud and Abuse laws.

Responsibilities

• Ensure timely and accurate insurance authorizations are in place prior to services.
• Verify insurance eligibility and benefit levels for identified services.
• Investigate pre-certification, authorization, and referral requirements.
• Provide required information to payer with medical records or medical necessity letters.
• Collaborate with clinical contacts for escalation to peer-to-peer review.
• Communicate with patients, clinicians, and financial counselors to facilitate authorization.
• Prioritize workload to handle urgent cases promptly.
• Maintain accurate documentation in all applications and systems.
• Adhere to departmental policies if authorization is not obtained before service date.
• Answer provider and patient questions about authorization requirements.
• Handle escalated authorization requests as needed.
• Provide mentorship to team members.

Skills

Prior-authorization

Attention to detail

Communication skills

Team collaboration

Regulatory compliance

Education

Associate degree in healthcare administration

Tools

Athena

Job description

CardioOne is seeking an experienced Prior-Authorization Specialist to join our remote team. You will obtain and verify prior authorizations for procedures, diagnostics, and other services, ensuring timely, policy-compliant approvals.

You will collaborate with providers, patients, and insurers, maintain accurate documentation, and escalate when needed. Reporting to the Associate Director of Revenue Cycle Management, you will help sustain clean, efficient authorization workflows.