Prior Authorization Specialist

CardioOne

. Obtain and verify prior authorizations within the appropriate timeline for procedures, diagnostic tests, and other services .

Posted 10/30/2026full-timeRemote • United StatesMid-LevelSenior💰 $21 - $27 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in obtaining and verifying insurance authorizations, ensuring compliance with regulations such as OSHA and HIPAA, and coordinating medical records for payer communication. Proficient in clinical documentation review and familiar with medical office procedures and billing practices.

Highest-signal resume keywords

Insurance Authorization ManagementClinical Documentation ReviewAthena ExperienceHealthcare CompliancePatient Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance Eligibility VerificationPre-Certification InvestigationMedical Records CoordinationDocumentation AccuracyBilling Practices Familiarity

Soft Skills

CollaborationMentorshipCommunication

Tools & Technologies

Athena

Industry Keywords

Healthcare AdministrationCardiology ExperienceOSHA ComplianceHIPAA ComplianceFederal Fraud and Abuse Laws

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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
Familiarity with medical office procedures and billing practices
Cardiology experience preferred
Athena experience required
Proficient in clinical documentation review for alignment with insurance authorization requirements
Compliance with OSHA, HIPAA, and Federal Fraud and Abuse laws and guidelines
Must be located in Colorado, Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, or Texas

Benefits

Comp & perks

Medical benefits
Dental benefits
Vision benefits
Matching 401(k)