Prior Authorization Specialist

CardioOne•Denver, CO

23h•$21 - $27•Remote

About The Position

CardioOne is seeking an experienced, detail-oriented Prior Authorization Specialist to obtain and verify prior authorizations for procedures, diagnostic tests, and other services within appropriate timelines. The role ensures requests comply with insurer policies, guidelines, and healthcare regulations, and works with healthcare providers, patients, and insurance representatives to secure required approvals. The position reports directly to the Associate Director of Revenue Cycle Management. This is a full-time remote position available to candidates in Colorado (Denver preferred), Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, and Texas. The hourly pay range is $21.00–$27.00, depending on years of relevant experience. CardioOne provides medical, dental, and vision benefits and a matching 401(k).

Requirements

A minimum of 3–5 years of experience in the same role or a related field in a healthcare setting.
Familiarity with medical office procedures and billing practices.
Athena experience.
Proficiency in reviewing clinical documentation for alignment with insurance authorization requirements.
Compliance with applicable regulatory requirements and guidelines, including OSHA, HIPAA, and Federal Fraud and Abuse laws.

Nice To Haves

Associate’s degree in healthcare administration or business administration preferred.
Cardiology experience preferred.

Responsibilities

Ensure timely and accurate insurance authorizations are in place before services are rendered.
Verify insurance eligibility and benefit levels to confirm coverage for identified services.
Verify and investigate pre-certification, authorization, and referral requirements for services.
Coordinate and provide information to payer review organizations, including medical records and letters of medical necessity, to support benefit determinations.
Collaborate with designated clinical contacts on encounters requiring escalation to peer-to-peer review.
Communicate with patients, clinical partners, financial counselors, and others to facilitate the authorization process.
Prioritize workload so urgent cases are handled in a timely manner.
Complete accurate documentation in all applications.
Follow departmental policies and procedures when authorization is not obtained before the service date.
Answer provider, staff, and patient questions about insurance authorization requirements.
Handle escalated authorization requests as needed.
Provide team mentorship as needed.
Perform other duties as assigned.