The Prior Authorization Specialist coordinates scheduling and insurance authorization for invasive and non-invasive cardiac procedures. This role works closely with physicians, clinical staff, hospitals, insurance companies, and patients to ensure procedures are scheduled accurately, authorizations are obtained on time, and patients receive clear instructions about their care.
Responsibilities include:
- Obtain and manage insurance prior authorizations for 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.
- Track pending authorizations, identify delays, and communicate issues to 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 documentation of authorizations and scheduled procedures in the electronic medical record.
- Collaborate with physicians, clinical teams, and administrative staff to resolve scheduling and authorization issues.
- Monitor upcoming procedures to confirm all authorization and scheduling requirements are complete before the date of service.
- Maintain patient confidentiality and comply with HIPAA regulations.
Requirements & Qualifications
Required qualifications:
- 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 and 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 qualifications:
- 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.
Location
Connecticut, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
3 weeks ago