Prior Authorization Specialist

About the role

The Prior Authorization Specialist plays a vital role in ensuring that patients receive the necessary pre-certifications and authorizations for procedures and medications. This full-time position is designed for individuals who are passionate about providing high-quality care in a fast-paced cardiology environment. The specialist will be responsible for managing prior authorization requests, collaborating with healthcare team members, and ensuring compliance with insurance requirements.

Responsibilities

• Obtain pre-certifications and pre-authorizations for procedures and medications
• Contact insurance carriers to verify patient's insurance eligibility, benefits, and requirements
• Review patient medical records to ensure eligibility based on payer and Cardiology Center guidelines
• Request, track, and obtain pre-authorizations from insurance carriers within the allotted time
• Prioritize incoming prior authorization requests according to need and urgency
• Initiate and coordinate appeals for any denied prior authorizations
• Communicate prior authorization status and updates directly to patients
• Maintain a level of productivity suitable for the department

Requirements

• Knowledge of medical terminology including treatments and surgical procedures
• Understanding of insurance and billing processes in healthcare
• Ability to maintain confidentiality and comply with HIPAA regulations
• Proficiency in Microsoft Office and EMR software
• Excellent organizational skills and attention to detail
• Strong communication skills and ability to work cooperatively with others
• Minimum high school diploma or GED equivalent
• Previous employment as a Prior Authorization Specialist

Qualifications

• Minimum of 1-2 years of experience in cardiology prior authorization