Remote Prior Authorization Specialist – Cardiology RCM

CardioOne; Denver (CO); Remote; USD 29,000 - 37,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401K matching

Job summary

CardioOne, a physician-led, tech-driven cardiology platform, seeks a Prior-Authorization Specialist to obtain and verify authorizations for procedures and services. You will work with providers, patients, and insurers to ensure timely approvals.

This full-time, remote role (Colorado preferred) offers benefits including medical, dental, vision, and a matched 401(k); requires 3–5 years in a similar role and Athena experience.

Qualifications

• Associate degree preferred in healthcare administration or business administration.
• 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 reviewing clinical documentation to align with authorization requirements.
• Compliance with HIPAA and other regulatory guidelines.

Responsibilities

• Ensure timely and accurate pre-service authorizations are in place.
• Verify insurance eligibility and benefits for identified services.
• Investigate pre-certification, authorization, and referral requirements.
• Provide payer information including medical necessity and documentation as needed.
• Escalate to peer-to-peer review when necessary and liaise with providers and patients.
• Prioritize urgent cases and document thoroughly in systems.

Skills

Healthcare administration

Clinical documentation review

Communication with payers

Education

Associate’s degree in healthcare administration or business administration

Tools

Athena

Job description

CardioOne, a physician-led, tech-driven cardiology platform, seeks a Prior-Authorization Specialist to obtain and verify authorizations for procedures and services. You will work with providers, patients, and insurers to ensure timely approvals.

This full-time, remote role (Colorado preferred) offers benefits including medical, dental, vision, and a matched 401(k); requires 3–5 years in a similar role and Athena experience.