Prior Authorization Specialist US Heart & Vascular - 3.3 Birmingham, AL Job Details Full-time 16 hours ago Qualifications OSHA (regulatory compliance area) HIPAA compliance Medical office experience Regulatory compliance HIPAA High school diploma or GED Clinical documentation Document review Full Job Description US Heart and Vascular is in need of a Cardiology Prior Authorizations Specialist to join our team at Birmingham Cardiology in Birmingham, AL. If you have a passion for obtaining prior authorizations for Veins, Structural Heart and CT Studies, please join our US Heart and Vascular team

Responsibilities:

Ensures timely and accurate insurance authorizations are in place prior to services being rendered. Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt. Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services. Coordinates and supplies information to the review organization (payer) including medical record information and/or letter of medical necessity for determination of benefits. Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review. Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process. Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. Completes accurate documentation in all applications. Follows departmental policies and procedures, when necessary, authorization is not obtained before the service date. Answers provider, staff, and patient questions surrounding insurance authorization requirements. Handles escalated authorization requests as needed. Provides team mentorship as needed. Works other departmental tasks as needed.

Requirements:

Familiarity with medical office procedures and billing practices Proficient in clinical documentation review for alignment with insurance authorization requirements Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws. High School Diploma or equivalent required 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. ECW experience is preferred.

About Birmingham, AL:

Birmingham blends history, culture, and a growing job market. The city offers a mix of urban energy and Southern charm. Residents enjoy outdoor spaces, great food, and an affordable cost of living. It's a welcoming place with something for everyone.