The Prior Authorization Specialist is responsible for coordinating the scheduling and insurance authorization of invasive and non-invasive cardiac procedures. This position works closely with physicians, clinical staff, hospitals, insurance companies, and patients to ensure procedures are scheduled accurately, authorizations are obtained in a timely manner, and patients receive clear instructions regarding their scheduled services. The ideal candidate is highly organized, detail-oriented, and able to manage multiple priorities in a fast-paced cardiology practice.
Essential Duties and Responsibilities
- Obtain and manage insurance prior authorizations for invasive and non-invasive cardiac procedures, including cardiac catheterizations, electrophysiology procedures, vascular studies, cardiac CT, and other diagnostic or interventional services.
- Coordinate procedure scheduling with hospitals, outpatient facilities, physicians, and patients.
- Submit authorization requests with appropriate clinical documentation and follow up with insurance carriers to ensure timely approvals.
- Track pending authorizations, identify potential delays, and communicate issues to the appropriate clinical staff.
- Assist with denied authorizations, appeals, and peer-to-peer review coordination as needed.
- Ensure accuracy of procedure orders, diagnosis codes, CPT codes, and supporting documentation.
- Communicate procedure dates, times, preparation instructions, and other relevant information to patients.
- Maintain accurate and timely documentation of authorizations and scheduled procedures within the electronic medical record.
- Collaborate with physicians, clinical teams, and administrative staff to resolve scheduling conflicts and authorization issues.
- Monitor upcoming procedures to ensure all necessary authorizations and scheduling requirements are completed prior to the date of service.
- Maintain patient confidentiality and comply with HIPAA regulations.
- Perform other related duties as assigned.
Required:
- High school diploma or equivalent.
- Experience in medical office administration, procedure scheduling, insurance verification, or prior authorizations.
- Working knowledge of medical terminology and health insurance processes.
- Strong organizational skills with excellent attention to detail.
- Ability to manage multiple tasks, meet deadlines, and prioritize effectively.
- Excellent communication and customer service skills.
- Proficiency with electronic medical records and standard computer applications.
Preferred:
- Previous experience in a cardiology practice or cardiovascular service line.
- Experience obtaining authorizations for diagnostic imaging, cardiac testing, and invasive procedures.
- Familiarity with CPT and ICD-10 coding.
- Knowledge of commercial insurance, Medicare, Medicaid, and managed care authorization requirements.
- Experience coordinating procedures with hospital scheduling departments.
Key Competencies
- Strong attention to detail and accuracy
- Effective time management and follow-through
- Ability to work independently and collaboratively
- Strong problem-solving and critical-thinking skills
- Professional and compassionate patient communication
- Ability to adapt to changing priorities in a busy clinical environment
The UConn Health Community Network is a not-for-profit organization created to extend UConn Health’s mission by partnering with community hospitals and connecting them to its clinical expertise, academic strength, and operational resources.
Today, the network is a thriving community‑based system of care serving more than 280,000 residents across the region. It employs over 2,000 professionals and supports a medical staff of roughly 700 clinicians.
At its core is Waterbury Hospital, a 347‑bed community teaching hospital affiliated with the University of Connecticut School of Medicine. Alongside Connecticut Children’s, the UConn Health Community Network Medical Group, Access Rehab Centers, and its role as a leading partner in the Harold Leever Cancer Center, the network has been shaping the region’s healthcare landscape for more than 130 years.
And Waterbury Hospital is only the beginning - the network is designed for continued growth, deeper partnerships, and broader regional impact.