Authorization Specialist

Job description

The Prior Authorization Specialist is responsible for coordinating the scheduling and insurance authorization of invasive and non-invasive cardiac procedures. This position works closely with physicians, clinical staff, hospitals, insurance companies, and patients to ensure procedures are scheduled accurately, authorizations are obtained in a timely manner, and patients receive clear instructions regarding their scheduled services.
The ideal candidate is highly organized, detail-oriented, and able to manage multiple priorities in a fast-paced cardiology practice.
Essential Duties and Responsibilities
• Obtain and manage insurance prior authorizations for invasive and non-invasive cardiac procedures, including cardiac catheterizations, electrophysiology procedures, vascular studies, cardiac CT, and other diagnostic or interventional services.
• Coordinate procedure scheduling with hospitals, outpatient facilities, physicians, and patients.
• Submit authorization requests with appropriate clinical documentation and follow up with insurance carriers to ensure timely approvals.
• Track pending authorizations, identify potential delays, and communicate issues to the appropriate clinical staff.
• Assist with denied authorizations, appeals, and peer-to-peer review coordination as needed.
• Ensure accuracy of procedure orders, diagnosis codes, CPT codes, and supporting documentation.
• Communicate procedure dates, times, preparation instructions, and other relevant information to patients.
• Maintain accurate and timely documentation of authorizations and scheduled procedures within the electronic medical record.
• Collaborate with physicians, clinical teams, and administrative staff to resolve scheduling conflicts and authorization issues.
• Monitor upcoming procedures to ensure all necessary authorizations and scheduling requirements are completed prior to the date of service.
• Maintain patient confidentiality and comply with HIPAA regulations.
• Perform other related duties as assigned.

Required:
• High school diploma or equivalent.
• Experience in medical office administration, procedure scheduling, insurance verification, or prior authorizations.
• Working knowledge of medical terminology and health insurance processes.
• Strong organizational skills with excellent attention to detail.
• Ability to manage multiple tasks, meet deadlines, and prioritize effectively.
• Excellent communication and customer service skills.
• Proficiency with electronic medical records and standard computer applications.

Preferred:
• Previous experience in a cardiology practice or cardiovascular service line.
• Experience obtaining authorizations for diagnostic imaging, cardiac testing, and invasive procedures.
• Familiarity with CPT and ICD-10 coding.
• Knowledge of commercial insurance, Medicare, Medicaid, and managed care authorization requirements.
• Experience coordinating procedures with hospital scheduling departments.

Key Competencies
• Strong attention to detail and accuracy
• Effective time management and follow-through
• Ability to work independently and collaboratively
• Strong problem-solving and critical-thinking skills
• Professional and compassionate patient communication
• Ability to adapt to changing priorities in a busy clinical environment