Cardiology Prior Authorization Specialist

Roles and Responsibilities

• Review medical records, including patient history, symptoms, and treatment plans.
  
• Determine if services align with established guidelines and criteria for coverage.
  
• Verify patient eligibility and benefits prior to service delivery.
  
• Communicate effectively with healthcare providers regarding authorization status.
  
• Maintain accurate documentation of all interactions.
  

Desired Candidate Profile

• 2-5 years of experience in Prior Authorization or related field (e.g., RCM).
  
• Strong understanding of US Healthcare regulations and insurance verification processes.
  
• Proficiency in CPT coding (specifically for cardiac procedures like 93000 series) and ICD-10 Coding.