Prior Authorization Specialist

This is a Fully Remote Job About Our Client: The organization operates in the cardiology healthcare sector, focusing on supporting independent cardiology practices. It addresses the challenge of maintaining physician autonomy amid a complex healthcare environment by providing technology-driven solutions and operational expertise. The platform integrates services such as revenue cycle management, imaging, and practice development to enhance growth, efficiency, and patient outcomes. The organization is backed by healthcare investors and executives and aims to build a scalable management services organization for cardiology. About the Opportunity: The PRIOR AUTHORIZATION SPECIALIST role is focused on managing insurance prior authorizations for medical procedures and services. This position ensures timely and accurate approvals, compliance with insurance policies and healthcare regulations, and effective coordination among providers, patients, and insurers. The role contributes to the organization's revenue cycle by facilitating service delivery through proper authorization processes. Responsibilities: Obtain and verify insurance authorizations within required timelines. Verify insurance eligibility and benefit coverage before services. Investigate pre-certification and referral requirements. Provide payers with necessary medical documentation for benefit determinations. Collaborate with clinical contacts on cases needing peer-to-peer review. Communicate with patients, clinical partners, and financial counselors to support the authorization process. Prioritize workload to address urgent cases promptly. Document all activities accurately in relevant systems. Adhere to departmental policies for handling authorizations. Respond to questions from providers, staff, and patients regarding authorization requirements. Manage escalated authorization requests as needed. Provide mentorship to team members when required. Perform other duties as assigned. Requirements: Associate’s degree in healthcare administration or business administration preferred. Three to five years of experience in prior authorization or a related healthcare role. Knowledge of medical office procedures and billing practices. Experience in cardiology preferred. Proficiency with Athena software required. Ability to review clinical documentation for insurance authorization alignment. Knowledge of regulatory compliance including OSHA, HIPAA, and Federal Fraud and Abuse laws. Pay Range and Compensation Package: Hourly pay range of $21.00 to $27.00, based on relevant experience. Medical, dental, and vision benefits included. 401(k) plan with matching available. Benefits & Perks: Medical insurance Dental insurance Vision insurance 401(k) matching Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note: TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.