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

401K matching

Job summary

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.

Qualifications

• 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).

Responsibilities

• 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.

Skills

Regulatory compliance

Insurance verification

Clinical documentation review

Attention to detail

Education

Associate’s degree in healthcare administration or business administration

Tools

Athena experience

Job description

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.