Location: Sun City West, AZ
About the Role: We are a growing cardiovascular clinic seeking a highly skilled, elite Prior Authorization Specialist dedicated exclusively to securing approvals for Radiofrequency Ablation (RFA) procedures. This role is built for a master of payer policies who takes pride in maintaining a near-zero denial rate. If you are an expert at navigating complex clinical guidelines and refuse to let paperwork delay patient care, you will thrive in our high-performance environment.
What You Will Do:
- Command the RFA Pipeline: Own the end-to-end authorization process solely for RFA procedures, moving cases from medical necessity review to final approval with urgency and precision.
- Analyze Clinical Data: Deconstruct ultrasound reports, reflux times, conservative therapy logs, and clinical notes to build bulletproof authorization packets.
- Outmaneuver Payer Hurdles: Utilize your deep knowledge of LCDs (Local Coverage Determinations) and commercial payer policies to anticipate and neutralize obstacles before they cause delays.
- Lead Appeals & Escalations: Strategically craft and submit high-level appeals, peer-to-peer packets, and clinical arguments to overturn unjust denials.
- Collaborate Professionally: Act as the clinic’s elite liaison between care teams, providers, and major insurance payers (including Medicare and AHCCCS).
What We Are Looking For:
- Vascular Expertise: 3+ years of dedicated medical prior authorization experience, with a heavy emphasis on vein, vascular, or interventional radiology procedures.
- RFA Mastery: Proven deep familiarity with RFA-specific CPT codes (e.g., 36475, 36476) and strict payer criteria for venous insufficiency.
- Policy Fluency: Exceptional ability to read, interpret, and apply complex insurance medical policies and LCD guidelines.
- Tech-Savvy Auditor: High proficiency in navigating electronic medical records (EMR) and various insurance portals efficiently.
Qualifications
- Healthcare | Medical Experience required
- Registered Medical Assistant (RMA) or Certified Medical Assistant (CMA) required for this position
- Cardiology experience preferred (familiarity with cardiac testing, procedural coordination, or cardiovascular studies is a plus)
- Spanish-speaking is a plus but not required
- Strong organizational and communication skills required
Work Location and Schedule:
- Primary Clinic: Sun City West, AZ (with occasional coverage/travel to Sun City; mileage reimbursed)
- Hours: Full-time, Monday through Friday, 8:00 AM to 5:00 PM (No weekends, holidays, or after-hours required)
Compensation and Benefits Package
- Salary: $24.00 per hour DOE
- Benefits include: Paid time off and sick leave, Birthday Floating Day, Anniversary Floating Day incentives, opportunities for professional development and training, a supportive and inclusive work environment, mileage reimbursement for travel between clinic locations
Interview Process and Hiring Timeline
- Interviews: 1st screening phone interview followed by 2nd in-person interview
- Hiring Timeline: Looking to hire within 1-2 weeks
Pay: From $24.00 per hour
Benefits:
Application Question(s):
- How many years of prior authorization experience do you have specifically for vein, vascular, or interventional radiology procedures?
- Do you have prior authorization experience with Radiofrequency Ablation (RFA) procedures?
- Are you familiar with Local Coverage Determinations (LCDs) and how they apply to venous insufficiency treatments?
- Do you have experience navigating payer portals and EMR systems for vein/RFA cases?
Work Location: In person
