Prior Authorization Specialist (3176)

• DescriptionUS 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.