Prior Authorization Specialist

Job not on LinkedIn

🔥 12 hours ago

⛰️ Colorado, Florida, +4 more states – Remote

⛰️ Colorado – Remote 🐊 Florida – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $21 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CardioOne

WebsiteLinkedInAll Job Openings

1 - 10 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

CardioOne is a company dedicated to supporting cardiology practices in maintaining independence and achieving growth. They provide services and tools tailored for cardiologists who are either already independent or are aiming to transition to private practice. CardioOne's offerings include a purpose-built technology platform, practice optimization programs, strategic growth planning, staff management, and contract negotiation support, all with a focus on value-based care. Their aim is to enhance clinical capabilities, improve operational efficiencies, and reduce administrative burdens so cardiologists can focus on patient care. In doing so, CardioOne empowers cardiologists to thrive independently while maintaining control over their practice decisions and operations.

📋 Description

• Obtain and verify prior authorizations within the appropriate timeline for procedures, diagnostic tests, and other services • Ensure timely and accurate insurance authorizations are in place before services are rendered • Verify insurance eligibility and benefit levels • Investigate pre-certification, authorization, and referral requirements • Coordinate and supply medical records and letters of medical necessity to payers • Collaborate with clinical contacts on cases requiring peer-to-peer review • Communicate with patients, clinical partners, financial counselors, providers, and insurance representatives • Prioritize urgent cases • Complete accurate documentation in all applications • Follow departmental policies and procedures when authorization is not obtained before the service date • Answer questions about insurance authorization requirements • Handle escalated authorization requests • Provide team mentorship as needed • Perform other duties as assigned

🎯 Requirements

• 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 • Compliance with OSHA, HIPAA, and Federal Fraud and Abuse laws and guidelines • Must be located in Colorado, Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, or Texas

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • Matching 401(k)

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