Back to search
Job DetailsJob Location: BHC - Medical Drive Main - Birmingham, AL 35235Position Type: Full TimeEducation Level: High School Diploma/GEDJob Category: Other PositionsUS 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. Qualifications
Learn more about this Employer on their Career Site
