Full employer posting
The Prior Authorization Specialist is responsible for coordinating the scheduling and insurance authorization of invasive and non-invasive cardiac procedures. This position works closely with physicians, clinical staff, hospitals, insurance companies, and patients to ensure procedures are scheduled accurately, authorizations are obtained in a timely manner, and patients receive clear instructions regarding their scheduled services.
The ideal candidate is highly organized, detail-oriented, and able to manage multiple priorities in a fast-paced cardiology practice.
and Responsibilities Obtain and manage insurance prior authorizations for invasive and non-invasive cardiac procedures, including cardiac catheterizations, electrophysiology procedures, vascular studies, cardiac CT, and other diagnostic or interventional services. Coordinate procedure scheduling with hospitals, outpatient facilities, physicians, and patients. Submit authorization requests with appropriate clinical documentation and follow up with insurance carriers to ensure timely approvals.
Track pending authorizations, identify potential delays, and communicate issues to the appropriate clinical staff. Assist with denied authorizations, appeals, and peer-to-peer review coordination as needed. Ensure accuracy of procedure orders, diagnosis codes, CPT codes, and supporting documentation.
Communicate procedure dates, times, preparation instructions, and other relevant information to patients. Maintain accurate and timely documentation of authorizations and scheduled procedures within the electronic medical record. Collaborate with physicians, clinical teams, and administrative staff to resolve scheduling conflicts and authorization issues.
Monitor upcoming procedures to ensure all necessary authorizations and scheduling requirements are completed prior to the date of service. Maintain patient confidentiality and comply with HIPAA regulations. Perform other related duties as assigned.
Required: High school diploma or equivalent. Experience in medical office administration, procedure scheduling, insurance verification, or prior authorizations. Working knowledge of medical terminology and health insurance processes.
Strong organizational skills with excellent attention to detail. Ability to manage multiple tasks, meet deadlines, and prioritize effectively. Excellent communication and customer service skills.
Proficiency with electronic medical records and standard computer applications. Preferred: Previous experience in a cardiology practice or cardiovascular service line. Experience obtaining authorizations for diagnostic imaging, cardiac testing, and invasive procedures.
Familiarity with CPT and ICD-10 coding. Knowledge of commercial insurance, Medicare, Medicaid, and managed care authorization requirements. Experience coordinating procedures with hospital scheduling departments.
Key Competencies Strong attention to detail and accuracy Effective time management and follow-through Ability to work independently and collaboratively Strong problem-solving and critical-thinking skills Professional and compassionate patient communication Ability to adapt to changing priorities in a busy clinical environment
Full time · Day shift
About the role
Obtain and manage insurance prior authorizations for invasive and non-invasive cardiac procedures, including cardiac catheterizations, electrophysiology procedures, vascular studies, cardiac CT, and other diagnostic or interventional services.