Prior Authorization Manager

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

CardioOne is seeking an Authorization Manager to own the prior authorization function across our growing network of cardiology practice partners. This is a hybrid individual contributor and people leadership role you will be both hands-on in the work and responsible for managing external vendor relationships and internal authorization operations at scale.

The Authorization Manager serves as the central accountability point for authorization outcomes across CardioOne's practice portfolio, with a particular focus on de novo practice launches where enhanced services authorization complexity is highest and vendor coordination is most critical. This role operates within CardioOne's dual-track authorization model, the regular workflow and the enhanced services workflow and is expected to own performance and compliance across both.

What you'll do:

Authorization Operations & Tracker Oversight

• Own and continuously improve theCardioOneauthorization tracker, ensuring data integrity, status accuracy, and actionable visibility across all practice partners

• Monitor authorization approval rates, denial trends, turnaround times, and pend resolution across the network,escalating issues and driving corrective action

• Develop and enforce standardized authorization workflows, routing protocols, documentation requirements, and submission standards across practice entities

• Supportcommand of tracker statuses across both workflow models and ensure nothing falls through the cracks between the EHR's managed service, third-party vendors, and the stateside RCM team

• Ensure all authorization activityis documentedwithin the practice management system perCardioOnestandards not externally or verbally only

Vendor Management

• Serve as the primary liaison betweenCardioOneand third-party authorization vendors responsible for enhanced services authorization across practice partners

• Enforce established service level agreements, communication cadences, and performancestandards, includingsubmission as urgent/expeditedwithout exception, daily follow-up on high-priority cases, andtimelyescalation protocols

• Conduct regular vendor performance reviews against defined benchmarks and escalate gaps to leadership

• Ensure vendors havetimelyaccess to clinical documentation, payer requirements, CPT codes, and practice-specific routing information needed to execute authorizations effectively

• Hold vendors accountable to documentation standards, includingproperly detaileddenial appeal notations and "No Auth Required" reference documentation

• Serve as the escalation point when vendor submissions require intervention or authorizationsremainunresolved past defined thresholds

Enhanced Services Authorization - CTA Add-OnServices

• Oversee the CTA add-on authorization workflow forPlaque Analysisand Ischemia Analysis/FFRct,whichworksentirely outside standard vendor and EHR-managed authorization pathways

• Ensure the stateside RCM team is placing authorizations on holdat onceupon receipt,submittingto payers prior to any vendor triggering, and documenting all activity within the practice management system

• Monitor CAD-RADS-based clinical criteria compliance, diagnosis code accuracy, and alignment with approved order sets for analysis vendors

• MaintaintheFFRctpilot patient tracker and coordinate with clinical and RCM staff on payer-specific commercial criteria as theyare finalized

De Novo Practice Onboarding

• Partner with practice onboarding teams to build authorization workflows for newCardioOnepractice partners from the ground up,setting uprouting structures, tracker configuration, vendor handoffs, and escalation paths before go-live

• Coordinate with authorization vendors to ensure coverage is fully operational at the time of launch

• Identifypayer-specific authorization requirements for each new market and translate those into tracker infrastructure and vendor briefs

Team Leadership & Cross-Functional Collaboration

• Provide informal or formal oversight to authorization staff, including workload management, quality review, training, and performance feedback as the team scales

• Collaborate cross-functionally with RCM leadership, credentialing, clinical operations, scheduling staff, and practice administrators to resolve authorization-related barriers to care and revenue

• Contribute to reporting and analytics surfacing authorization performancetrends, approvalrates, denial patterns, turnaround benchmarks, and vendor service level agreement adherence to senior leadership

• Maintainongoing oversight of high-urgency authorization workflows, STAT prior authorization escalation processes, and facility notification requirements across practice entities

What you'll need:

• 5+ years of experience in prior authorization, revenue cycle, or medicalbilling, withmeaningful exposure to cardiology or cardiovascular specialty care

• Demonstratedexperience managing or coordinating with external authorization vendors or outsourced teams, including holding vendors to defined SLAs

• Strong working knowledge of commercial and government payer authorization requirements for cardiovascular services, with particular emphasis on cardiac imaging and cardiology procedures

• Proficiencywith athenaOne (athenaCollector) or comparable EHR/practice management platforms, including authorization tracker workflows

• Exceptional organizational skills and the ability to manage authorization operations across multiple simultaneous practice environments

• Strong written and verbal communication skills,able to hold vendors accountable professionally, escalate issues clearly, and translate workflow complexity for clinical and scheduling staff

• Self-starter with demonstrated ability to build accountability and a high-performance work culture across distributed teams (RCM, clinical, scheduling, and vendor partners), driving consistent execution and work ethic across entities

• Prior experience authorizing cardiac imaging services including cardiac CT/CTA, PET MPI, echocardiography, nuclear medicine, and cardiac monitoring (MCT/MCOT,Holter,ILR) isa significant advantage and willbe weightedheavily in candidate evaluation

• Cardiology procedure authorization experience**, including surgical and interventional cardiovascular procedures, is a strong plus

• Experience with enhanced services authorization workflows including CTA add-on services such as plaque analysis andFFRct/ischemia analysis,is highly desirable

• Familiarity with de novo or newly launched medical practice environments

• Background in multi-entity or MSO/practice management organization settings

• Experience building or redesigning authorization workflows, routing structures, and escalation frameworks from the ground up

Work Location:

• Remote: Colorado (preferred), Washington (preferred), Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, Texas.

Additional Information

Full-time base salary range of $62,000 to $68,000 plus medical, dental, and vision benefits. This role will has a matching 401K.

Department Revenue Cycle Management Locations Remote