Prior Authorization Manager

CardioOne•Denver, CO

17h•$62,000 - $68,000•Remote

About The Position

CardioOne is seeking an Authorization Manager to own the prior authorization function across our growing network of cardiology practice partners. This is a hybrid individual contributor and people leadership role you will be both hands-on in the work and responsible for managing external vendor relationships and internal authorization operations at scale. The Authorization Manager serves as the central accountability point for authorization outcomes across CardioOne’s practice portfolio, with a particular focus on de novo practice launches where enhanced services authorization complexity is highest and vendor coordination is most critical. This role operates within CardioOne’s dual-track authorization model, the regular workflow and the enhanced services workflow and is expected to own performance and compliance across both.

Requirements

5+ years of experience in prior authorization, revenue cycle, or medical billing, with meaningful exposure to cardiology or cardiovascular specialty care
Demonstrated experience managing or coordinating with external authorization vendors or outsourced teams, including holding vendors to defined SLAs
Strong working knowledge of commercial and government payer authorization requirements for cardiovascular services, with particular emphasis on cardiac imaging and cardiology procedures
Proficiency with athenaOne (athenaCollector) or comparable EHR/practice management platforms, including authorization tracker workflows
Exceptional organizational skills and the ability to manage authorization operations across multiple simultaneous practice environments
Strong written and verbal communication skills, able to hold vendors accountable professionally, escalate issues clearly, and translate workflow complexity for clinical and scheduling staff
Self-starter with demonstrated ability to build accountability and a high-performance work culture across distributed teams (RCM, clinical, scheduling, and vendor partners), driving consistent execution and work ethic across entities

Nice To Haves

Prior experience authorizing cardiac imaging services including cardiac CT/CTA, PET MPI, echocardiography, nuclear medicine, and cardiac monitoring (MCT/MCOT, Holter, ILR) is a significant advantage and will be weighted heavily in candidate evaluation
Cardiology procedure authorization experience, including surgical and interventional cardiovascular procedures, is a strong plus
Experience with enhanced services authorization workflows including CTA add-on services such as plaque analysis and FFRct/ischemia analysis, is highly desirable
Familiarity with de novo or newly launched medical practice environments
Background in multi-entity or MSO/practice management organization settings
Experience building or redesigning authorization workflows, routing structures, and escalation frameworks from the ground up

Responsibilities

Own and continuously improve the CardioOne authorization tracker, ensuring data integrity, status accuracy, and actionable visibility across all practice partners
Monitor authorization approval rates, denial trends, turnaround times, and pend resolution across the network, escalating issues and driving corrective action
Develop and enforce standardized authorization workflows, routing protocols, documentation requirements, and submission standards across practice entities
Support command of tracker statuses across both workflow models and ensure nothing falls through the cracks between the EHR’s managed service, third-party vendors, and the stateside RCM team
Ensure all authorization activity is documented within the practice management system per CardioOne standards not externally or verbally only
Serve as the primary liaison between CardioOne and third-party authorization vendors responsible for enhanced services authorization across practice partners
Enforce established service level agreements, communication cadences, and performance standards, including submission as urgent/expedited without exception, daily follow-up on high-priority cases, and timely escalation protocols
Conduct regular vendor performance reviews against defined benchmarks and escalate gaps to leadership
Ensure vendors have timely access to clinical documentation, payer requirements, CPT codes, and practice-specific routing information needed to execute authorizations effectively
Hold vendors accountable to documentation standards, including properly detailed denial appeal notations and “No Auth Required” reference documentation
Serve as the escalation point when vendor submissions require intervention or authorizations remain unresolved past defined thresholds
Oversee the CTA add-on authorization workflow for Plaque Analysis and Ischemia Analysis/FFRct, which works entirely outside standard vendor and EHR-managed authorization pathways
Ensure the stateside RCM team is placing authorizations on hold at once upon receipt, submitting to payers prior to any vendor triggering, and documenting all activity within the practice management system
Monitor CAD-RADS–based clinical criteria compliance, diagnosis code accuracy, and alignment with approved order sets for analysis vendors
Maintain the FFRct pilot patient tracker and coordinate with clinical and RCM staff on payer-specific commercial criteria as they are finalized
Partner with practice onboarding teams to build authorization workflows for new CardioOne practice partners from the ground up, setting up routing structures, tracker configuration, vendor handoffs, and escalation paths before go-live
Coordinate with authorization vendors to ensure coverage is fully operational at the time of launch
Identify payer-specific authorization requirements for each new market and translate those into tracker infrastructure and vendor briefs
Provide informal or formal oversight to authorization staff, including workload management, quality review, training, and performance feedback as the team scales
Collaborate cross-functionally with RCM leadership, credentialing, clinical operations, scheduling staff, and practice administrators to resolve authorization-related barriers to care and revenue
Contribute to reporting and analytics surfacing authorization performance trends, approval rates, denial patterns, turnaround benchmarks, and vendor service level agreement adherence to senior leadership
Maintain ongoing oversight of high-urgency authorization workflows, STAT prior authorization escalation processes, and facility notification requirements across practice entities