Function:

The Cardiology Authorization Coordinator works with the scheduling team, the providers, and third party payers for the purpose of obtaining prior authorization or pre-certification and resolves appeals to ensure payment for services. Compliance with rules and regulations of all applicable federal, state and local laws as well as CVIG policies and Medical Staff rules and regulations is a condition of employment.

Essential Duties & Responsibilities:

Incumbent must have the skills, ability and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodations.

• Obtains and reviews prior authorizations/precertification for all cardiology treatment and documentation for insurance carriers using carrier specific tools and or methods.
• Monitors, tracks, and follows up on authorization/certification requests.
• Ensures order has an indication or reason for visit that is medically necessary.
• Navigates websites for on-line insurance benefits review and authorization requirements.
• Ensures the prior authorization or precertification is for the correct services ordered and CPT/HCPCS codes match.
• Contacts referring physician offices to obtain prior authorization/precertification numbers.
• Works as a patient advocate and functions as a liaison between the patient and payer to answer routine and completed inquires, reimbursement questions and avoid insurance delays.
• Contacts the patient if any authorization/precertification issues.
• Initiates peer to peer reviews as necessary.
• Assists Member Services, Claims and Provider Services insurance department staff with issues that require medical interpretation or definition to resolve appeals.
• Maintains proficiency in reviewing medical records for evidence that care/services and need for care/services met the requirements of the patient’s insurance policy.
• Facilitate scheduling or rescheduling patients to accommodate authorization timelines.
• Schedules patient exams and studies, coordinating the times to best meet the needs of the patient and ordering physician.
• Builds and maintains collaborative relationships with both internal and external clients that lead to more effective communication and a higher level of productivity and accuracy.
• Performs phone reviews of prior authorization requests for appropriate care and approval of services or forward requests to the appropriate Physicians or Nurse Practioner with recommendations for other determinations

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Qualifications

• Education: Some college or continuing education preferred, High school or equivalent.
• Minimum 1-2 years of experience specializing in Cardiology (required).
• Athenahealth Superuser (preferred)
• Strong interpersonal skills.
• Exceptional time management and organizational skills.
• Must have knowledge of prior authorization processes for all insurance payers.

Benefits

• We offer competitive compensation
• Pay will be commensurate with experience and ability
• Insurance benefits available for you and your family

Job Type: Full-time

Pay: $43,000.00 - $53,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Application Question(s):

• Do you have experience working in Athena EMR system?
• Do you have experience working with a Cardiovascular specialty?

Experience:

• Prior authorization: 2 years (Required)

Ability to Relocate:

• Desoto, TX 75115: Relocate before starting work (Required)

Work Location: In person