Clinical Prior Authorization Specialist
Heartbeat Health
Full-time
Remote
Healthcare Insurance and Claims
Heartbeat Health is seeking an experienced Clinical Prior Authorization Specialist to join our Operations team! In this role, the employee will be required to work the hours of 9 am to 5 pm CST.
About the Gig:
- You’re a heart hero! You’ll be at the center of a wide range of mission-critical initiatives, helping Heartbeat make rapid progress in the experiences we deliver and optimizing the supporting systems
- Coordinate and obtain prior authorizations for medical services, diagnostic tests, procedures, and medications
- Review clinical documentation to determine medical necessity and payer requirements for prior authorizations
- Communicate with providers and clinical staff to gather additional information as needed for approval
- Document all authorization activities and payer communications in the electronic health record (EHR)
- Monitor pending authorizations and follow up to ensure timely approvals
- Notify providers and patients of authorization outcomes, including any denials or required appeals
- Collaborate with billing and scheduling teams to ensure authorization requirements are met before services are rendered
- Maintain up-to-date knowledge of payer rules, medical necessity criteria, and regulatory changes
- Assist with appeals processes when prior authorizations are denied
- Track and report authorization metrics, turnaround times, and approval rates
- Reduce delays in care, improve patient experience, and support Heartbeat’s revenue cycle
- Hours will be 9 am to 5 pm CST
About you:
- Minimum 2 years of prior authorization, utilization management, case management, or related healthcare experience
- Exceptional people skills and a GREAT communicator
- Strong clinical knowledge, attention to detail, and the ability to communicate effectively with healthcare providers, payers, and patients to ensure timely and accurate processing of authorizations
- Familiarity with payer portals, ICD-10, CPT, and HCPCS coding
- A team player with a high level of independence and proactivity
- Detail-oriented with a focus on processes
- Fast learner while being flexible and adaptable
- Outstanding organizational and multitasking abilities
- Self-driven and excited to support new technology
We are looking for an exceptional, experienced Clinical Prior Authorization Specialist. You’re an amazing problem solver who is open to new ideas, thoughtful in your approach, pragmatic in your delivery, constantly learning, and up for a challenge. You elevate the work of those around you.
We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
We do not accept unsolicited resumes from outside recruiters/placement agencies. Heartbeat will not pay fees associated with resumes presented through unsolicited means.