Hiring Pre-Authorization Specialist | US Healthcare | 4+ Years |Chennai | Full-Time

Job Summary:

The Authorization Specialist RCM (Cardiovascular) is responsible for securing timely and accurate prior authorizations for cardiovascular diagnostic and interventional procedures. This role plays a critical part in revenue integrity by ensuring payer compliance, minimizing denials, and supporting uninterrupted patient care across cardiology service lines.

Required Qualifications:

• High school diploma or equivalent (Associates degree preferred).
• 4+ years of experience in prior authorization or RCM, preferably in cardiology or cardiovascular services.
• Strong knowledge of cardiovascular procedures, medical terminology, and authorization workflows.
• Working knowledge of CPT, ICD-10-CM, and HCPCS codes related to cardiology.
• Experience with Medicare, Medicaid, and commercial payers.
• Proficiency in EHR systems and payer authorization platforms.

Preferred Skills & Competencies:

• Familiarity with cardiology-specific payer policies and medical necessity criteria.
• Ability to manage high volumes of complex authorizations under time-sensitive conditions.
• Strong attention to detail and documentation accuracy.
• Effective communication skills for interaction with providers, payers, and patients.
• Analytical mindset to identify root causes of authorization-related denials.

Key Responsibilities:

• Obtain prior authorizations for cardiovascular services including but not limited to:
• Cardiac catheterizations.
• Echocardiograms (TTE, TEE, stress echo).
• Nuclear cardiology and PET scans.
• Cardiac CT/MRI.
• Electrophysiology (EP) studies and ablations.
• Pacemaker, ICD, and CRT device implants.
• Vascular and interventional cardiology procedures.
• Review physician orders, clinical documentation, and medical necessity criteria prior to submission.
• Verify patient eligibility, benefits, authorization requirements, and payer-specific guidelines.
• Submit authorization requests through payer portals, phone, or fax with complete clinical documentation.
• Track and follow up on pending authorizations to ensure approvals prior to scheduled services.
• Communicate authorization outcomes to providers, scheduling, and billing teams.
• Initiate and manage peer-to-peer reviews when required.
• Support appeals for denied authorizations by compiling clinical documentation and payer correspondence.
• Maintain accurate authorization records in EHR and RCM systems.
• Ensure compliance with CMS, Medicare Advantage, Medicaid, and commercial payer policies.
• Identify authorization-related denial trends and collaborate with RCM leadership to improve processes.