Job Description

The Cardiac Procedure Prior Authorization Specialist is responsible for obtaining insurance authorizations for all cardiac testing and procedures ordered by our providers. This includes, but is not limited to - Echocardiograms, stress tests, nuclear studies, lower extremity arterial/venous studies, Holter and event monitors, cardiac catheterizations and venous insufficiency procedures. Knowledge of cardiac terminology preferred but not required. Will train in payer guidelines, and procedure workflows to ensure timely approvals and uninterrupted patient care.

Key Responsibilities:

Initiate, track, and complete prior authorizations for in-office and hospital-based cardiac procedures Review provider orders and confirm medical necessity documentation before submission Communicate directly with insurance companies to verify coverage and authorization requirements Accurately document all authorization details, reference numbers, and payer notes in the EMR Coordinate with schedulers to ensure no procedures are performed without approval Work closely with the testing and procedure scheduling teams to meet deadlines and prevent delays in care Monitor pending requests and follow up promptly on denials or additional documentation requests Stay current with payer policy updates and pre-certification processes

Qualifications:

High school diploma or equivalent required 1-2 years of experience in prior authorizations preferred but not required Strong understanding of CPT and ICD-10 coding related to cardiac testing and interventional procedures Experience working with insurance portals and EMR systems (eClinicalWorks preferred) Excellent communication, organization, and time management skills Ability to work independently and manage multiple authorizations simultaneously
Job Type: Full-time

Pay: $19.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance
Work Location: In person