CardioOne

Prior Authorization Specialist

• Obtain and verify prior authorizations within the appropriate timeline for procedures, diagnostic tests, and other services
• Ensure timely and accurate insurance authorizations are in place before services are rendered
• Verify insurance eligibility and benefit levels
• Investigate pre-certification, authorization, and referral requirements
• Coordinate and supply medical records and letters of medical necessity to payers
• Collaborate with clinical contacts on cases requiring peer-to-peer review
• Communicate with patients, clinical partners, financial counselors, providers, and insurance representatives
• Prioritize urgent cases
• Complete accurate documentation in all applications
• Follow departmental policies and procedures when authorization is not obtained before the service date
• Answer questions about insurance authorization requirements
• Handle escalated authorization requests
• Provide team mentorship as needed
• Perform other duties as assigned

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Prior Authorization Specialist