Pre-Authorization Spec
Carle Inclusion Connection Group, Champaign, IL, United States
Overview
The Pre-Authorization Specialist is responsible for identifying prior authorization requirements by insurance/payer, completing prior authorizations for scheduled and add-on services, determining covered benefits, and documenting pre-authorization information in Epic. The role communicates with the ordering provider's office regarding approvals or denials to reduce denials and facilitates peer-to-peer reviews when needed.
Qualifications
Certifications: __ , Education: __ , Work Experience: __
Proficiently utilizes third‑party payer/insurance portals to process pre‑auth submissions; detailed knowledge of insurance providers, portals, and authorization expectations. Ability to analyze required information, document results, and communicate with leadership, providers, and nurses about approvals or denials. Demonstrates patient and provider advocacy by processing pre‑auths quickly 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 issues.
Responsibilities
Analyze information to complete pre‑authorizations based on multiple insurance payer requirements and ensure coverage and insurance are correct. Document pre‑authorization results completely and communicate them to leadership, providers, and nurses. Advocate for patients and providers by processing pre‑auths time‑sensitively and collaborating with physicians and nurses to secure needed clinical information. Identify challenges, trends, and patterns and work with management to resolve them. Other duties as assigned.
Compensation and Benefits
The compensation range for this position is $18 per hour – $29.13 per hour. This represents the good‑faith minimum and maximum range for the role at the time of posting. Actual compensation offered to a candidate will depend 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.
Equal Opportunity Employer
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, or 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.
#J-18808-Ljbffr
The Pre-Authorization Specialist is responsible for identifying prior authorization requirements by insurance/payer, completing prior authorizations for scheduled and add-on services, determining covered benefits, and documenting pre-authorization information in Epic. The role communicates with the ordering provider's office regarding approvals or denials to reduce denials and facilitates peer-to-peer reviews when needed.
Qualifications
Certifications: __ , Education: __ , Work Experience: __
Proficiently utilizes third‑party payer/insurance portals to process pre‑auth submissions; detailed knowledge of insurance providers, portals, and authorization expectations. Ability to analyze required information, document results, and communicate with leadership, providers, and nurses about approvals or denials. Demonstrates patient and provider advocacy by processing pre‑auths quickly 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 issues.
Responsibilities
Analyze information to complete pre‑authorizations based on multiple insurance payer requirements and ensure coverage and insurance are correct. Document pre‑authorization results completely and communicate them to leadership, providers, and nurses. Advocate for patients and providers by processing pre‑auths time‑sensitively and collaborating with physicians and nurses to secure needed clinical information. Identify challenges, trends, and patterns and work with management to resolve them. Other duties as assigned.
Compensation and Benefits
The compensation range for this position is $18 per hour – $29.13 per hour. This represents the good‑faith minimum and maximum range for the role at the time of posting. Actual compensation offered to a candidate will depend 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.
Equal Opportunity Employer
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, or 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.
#J-18808-Ljbffr