Prior Authorization Specialist

Job Description

Job Description

The Prior Authorization Specialist  plays a vital role in ensuring that patients receive the necessary pre-certifications and authorizations for procedures and medications. This full-time position is designed for individuals who are passionate about providing high-quality care in a fast-paced cardiology environment. The specialist will be responsible for managing prior authorization requests, collaborating with healthcare team members, and ensuring compliance with insurance requirements. The ideal candidate will have a minimum of 1-2 years of experience in cardiology prior authorization, excellent organizational and communication skills, and the ability to maintain patient confidentiality in accordance with HIPAA standards. In this position, the specialist will triage prior authorization requests based on urgency, ensuring that patients receive timely care. They will communicate with insurance carriers to verify eligibility and benefits, track and obtain The specialist will work closely with the healthcare team to schedule outpatient procedures and treatments, ensuring a seamless experience for patients. This position offers a unique opportunity to make a significant impact on patient care while working in a supportive and collaborative environment.

Responsibilities

· Obtain pre-certifications and pre-authorizations for procedures and medications,

· Contact insurance carriers to verify patient's insurance eligibility, benefits, and requirements.

· Review patient medical records to ensure eligibility based on payer and Cardiology Center guidelines.

· Request, track, and obtain pre-authorizations from insurance carriers within the allotted time.

· Prioritize incoming prior authorization requests according to need and urgency.

· Initiate and coordinate appeals for any denied prior authorizations.

· Communicate prior authorization status and updates directly to patients.

· Maintain a level of productivity suitable for the department.

Requirements:

· Knowledge of medical terminology including treatments and surgical procedures.

· Understanding of insurance and billing processes in healthcare.

· Ability to maintain confidentiality and comply with HIPAA regulations.

· Proficiency in Microsoft Office and EMR software.

· Excellent organizational skills and attention to detail.

· Strong communication skills and ability to work cooperatively with others.

· Minimum high school diploma or GED equivalent.

· Previous employment as a Prior Authorization Specialist.

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