Job Description

Overview: The Pre-Authorization Specialist is responsible for identifying prior auth requirements by insurance/payer and processes and completes prior authorizations for scheduled and add on services. Determines if services are a covered benefit and documents pre-authorization information in Epic. Communicates with the ordering Provider's office if services were approved or denied to reduce denials and facilitates peer to peer reviews when needed. Responsibilities: Analyzes information required to complete pre-authorizations based on multiple insurance/payer requirements; ensures coverage/insurance is correct.Proficiently utilizes third party payer/insurance portals to process pre-auth submissions; has a detailed knowledge of insurance providers, their portals and expectations for authorization approval.Documents pre-authorization results completely and communicates to leadership, Providers and/or Nurses pre-authorization approvals or denials.Advocates for patients/providers by processing pre-auths in a time sensitive manner and collaborating with physicians and nurses to secure clinical information needed for submissions.Identifies challenges, trends and patterns and works with management to address and resolve.Other duties as assigned.Identifying prior auth requirements by insurance/payer and processes and completes prior authorizations for scheduled and add on services. Determines if services are a covered benefit and documents pre-authorization information in Epic. Communicates with the ordering Provider office if services were approved or denied to reduce denials and facilitates peer to peer reviews when needed. Qualifications:

Education: Highschool Diploma or G.E.D 

 

Required English Skills

Basic reading skills

Basic writing skills

Basic oral skills

 

Communication Skills

Ability to respond appropriately to customer/co-worker

Interaction with a wide variety of people

Maintain confidential information

Ability to communicate only the facts to recipients or to decline to reveal information

Ability to project a professional, friendly, helpful demeanor

 

Computer Skills

Basic computer knowledge: Uses word processing, spreadsheet, e-mail application, and web browser. Comfortable with Windows OS and learning new applications.

Carle Health Company Overview:

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance – and opportunities meet flexibility. Find it all at Carle Health.

 

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Health Alliance™. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Salary Range: The compensation range for this position is $18per hour - $29.13per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.

Job Tags

Full time, Work at office, Local area, Shift work,

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