Authorizations Representative

Position Summary The Authorizations Representative is responsible for obtaining, verifying, and tracking all medical authorizations and referrals required for patient services at United Heart Institute. This position ensures timely approval of procedures, diagnostic testing, and specialist visits while maintaining compliance with payer requirements and internal processes. The representative serves as a liaison between patients, providers, and insurance companies to ensure seamless coordination of care and efficient operations. Key Responsibilities · Obtain prior authorizations for diagnostic tests, procedures, imaging studies, and specialty services as required by insurance carriers. · Verify patient insurance eligibility and benefits prior to scheduled appointments. · Communicate with insurance companies to determine coverage, resolve denials, and follow up on pending requests. · Accurately document all authorization details and communications in the electronic health record (EHR) system. · Coordinate with providers and clinical staff to ensure necessary medical documentation and clinical notes are submitted for authorization. · Track authorization requests to completion and notify patients and providers of approval or denial statuses. · Maintain up-to-date knowledge of insurance payer requirements, CPT/ICD-10 coding, and medical necessity guidelines. · Assist with appeals for denied authorizations and collaborate with billing staff to resolve related issues. · Provide excellent customer service by responding promptly and professionally to patient and staff inquiries. · Perform other administrative duties as assigned to support office efficiency. Qualifications Education: High school diploma or equivalent required. College coursework or certification in medical billing, insurance, or health administration preferred. Experience: Minimum of 1–2 years of experience in medical authorizations, insurance verification, or billing within a healthcare setting (cardiology experience preferred). Knowledge: Strong understanding of insurance authorization procedures and medical terminology; familiarity with CPT, HCPCS, and ICD-10 codes; knowledge of payer requirements (HMO, PPO, Medicare, Medi-Cal, etc.). Skills: Excellent communication and customer service skills; strong organizational skills and attention to detail; proficient in EHR and practice management systems (experience with eClinicalWorks preferred); ability to multitask and meet deadlines in a fast-paced environment. Core Competencies · Accountability and Reliability · Effective Communication · Teamwork and Collaboration · Problem-Solving and Critical Thinking · Professionalism and Confidentiality · Time Management Physical Requirements Prolonged periods of sitting and working on a computer. Ability to lift up to 15 lbs occasionally. Manual dexterity required for data entry and handling paperwork. Work Schedule Full-time position, Monday through Friday, standard office hours. Occasional overtime may be required based on workload or patient care needs. Company DescriptionWork with a distinguished group of Cardiologists. Apply tot his job