Prior Authorization Specialist
About this role
About the Company
The next generation of independent cardiology is being built here. CardioOne is a physician-led, technology-driven cardiology platform built to empower independent practices to compete, and win, in a rapidly evolving healthcare landscape. Our mission is to provide cardiologists with the tools, infrastructure, and expertise they need to thrive while maintaining full clinical independence. We believe the best care is delivered by physicians who are empowered - not constrained - by the systems around them. We combine a deep bench of healthcare operators with purpose-built technology and AI-enabled solutions across operations, revenue cycle, imaging, and practice development. From real estate and advanced imaging to clinical workflows and data infrastructure, CardioOne delivers a fully integrated platform designed to drive growth, efficiency, and superior patient outcomes.
Backed by WindRose Health Investors and leading healthcare executives, CardioOne is building one of the most sophisticated and scalable cardiology MSOs in the country - designed to reimagine what is possible for independent cardiology.
About the Job
We’re seeking an experienced, detail-oriented Prior-Authorization Specialist to join our team at CardioOne. You will be responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, and other services. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations. The specialist will collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals. You will report directly to the Associate Director of Revenue Cycle Management.
What you’ll do:
Ensure timely and accurate insurance authorizations are in place prior to services being rendered.
Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services.
Coordinates and supplies information to the review organization (payer) including medical record information and/or letter of medical necessity for determination of benefits.
Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process.
Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner.
Completes accurate documentation in all applications.
Follows departmental policies and procedures, when necessary, authorization is not obtained before the service date.
Answers provider, staff, and patient questions surrounding insurance authorization requirements.
Handles escalated authorization requests as needed.
Provides team mentorship as needed.
Other duties as assigned.
What you’ll need:
Associate’s degree in healthcare administration or business administration preferred
A minimum of 3-5 years' experience in the same role, or related field in a healthcare setting is required.
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
Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws.
Work Location:
Remote: Colorado (Denver preferred), Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, Texas.
Additional Information
Full time position with an hourly range of $21.00-$27.00 dependent on years of relevant experience. This role will have medical, dental, and vision benefits along with a matching 401K.
Originally posted on Himalayas