Prior Authorization Specialist (3176)

Prior Authorization Specialist

US Heart and Vascular is in need of a Cardiology Prior Authorizations Specialist to join our team at Willowbrook Cardiovascular Associates in Houston, TX.

If you have a passion for obtaining prior authorizations for Veins, Structural Heart and CT Studies, please join our US Heart and Vascular team

Responsibilities:

• Ensures 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.
• Works other departmental tasks as needed.

Requirements:

• Familiarity with medical office procedures and billing practices
• 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.
• High School Diploma or equivalent required
• 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.
• ECW experience is preferred.

About Houston, TX:

Houston is a diverse city with a booming job market in energy, healthcare, and tech. It has no state income tax, an affordable cost of living, and world-class dining and entertainment. Green spaces, museums, and pro sports teams add to its appeal. Whether for career growth or culture, Houston has it all.