Insurance Authorization Specialist – Cardiology Practice
Location: Broward County / South Florida (Specify: On-site)
Job Type: Full-time / Office
Bilingual: English and Spanish
Salary Range: $20.00 - $24.00 / hour
Job Summary
We are seeking an experienced and detail-oriented Insurance Authorization Specialist to join our growing cardiology practice in South Florida. In this role, you will be responsible for securing prior authorizations for a high volume of complex cardiovascular procedures, diagnostic imaging, and interventions. The ideal candidate possesses deep knowledge of cardiology CPT/ICD-10 codes, utilization management portals, and medical necessity criteria to ensure seamless patient care and maximize practice revenue.
Key Responsibilities
- Prior Authorization Management: Obtain timely prior authorizations for non-invasive diagnostic tests (Echocardiograms, Stress Tests, Holter Monitors) and invasive procedures.
- eClinicalWorks (eCW) Workflow: Efficiently navigate eClinicalWorks to extract required clinical notes, track authorization statuses within patient charts, and document approval numbers and expiration dates.
- Utilization Portals: Navigate and submit clinical documentation through third-party utilization management platforms including EviCore, RadMD (NIA), Availity, and major commercial/Medicare Advantage portals (Florida Blue, Humana, Aetna, UHC).
- Medical Necessity Review: Audit electronic health records to extract clinical documentation (e.g., chest pain, dyspnea, syncope, abnormal EKGs) to substantiate medical necessity and prevent insurance denials.
- Denial & Appeal Handling: Identify root causes of authorization denials, correct coding errors, and collaborate with clinical staff to submit robust medical appeals.
- Peer-to-Peer Coordination: Actively schedule and coordinate urgent Peer-to-Peer reviews between our cardiologists and insurance medical directors to overturn denials.
- Patient & Clinic Communication: Update scheduling teams and patients regarding authorization status, potential out-of-pocket costs, or scheduling delays due to pending approvals.
Requirements & Qualifications
- Education: High School Diploma or equivalent; certification in Medical Coding, Billing, or Administration is a plus.
- Experience: Minimum of 2–3 years of medical prior authorization experience, specifically within a Cardiology practice or specialty setting.
- Software Proficiency: Strong, hands-on experience using eClinicalWorks (eCW) is highly preferred.
- Technical Skills: Deep familiarity with cardiovascular CPT codes (e.g., 93306, 93015, 93454) and ICD-10 coding.
- Knowledge: Strong understanding of South Florida commercial insurance plans, Medicare Advantage, and Managed Care guidelines.
- Soft Skills: Excellent written and verbal communication skills, strong organizational abilities, and a proactive approach to problem-solving.
- Bilingual Preferred: Fluency in English and Spanish is highly desired to serve our South Florida patient demographic.
Benefits
Paid Time Off (PTO) and paid holidays
Career growth opportunities within a leading healthcare network
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Pay: $20.00 - $24.00 per hour
Work Location: In person
