Hybrid Prior Authorization Specialist (Healthcare)

Keystone Advisors LLC; Matteson (IL); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Competitive Salary

Paid Time Off

Health, Vision & Dental Insurance

Health Savings Account (HSA)

Flexible Spending Account (FSA)

Short & Long Term Disability

401 (K) with company match

Life Insurance

Job summary

Keystone Advisors LLC in Matteson, IL is seeking a motivated Prior Authorization Specialist to join our team supporting a healthcare client. This hybrid role entails obtaining and processing prior authorization requests, coordinating calls, and entering data with providers and payers.

You will document communications, follow up on denials, and ensure timely approvals. Ideal candidates have knowledge of payer portals (Anthem, Availity, Evicor, CoverMyMeds, Magellan) and strong written and spoken

Qualifications

• Five years of prior authorization experience with a high school diploma or GED.
• Three years of experience processing insurance requests for prior authorization.
• Experience with payer portals such as Anthem, Availity, Evicor, CoverMyMeds, Magellan.

Responsibilities

• Reviews accounts and initiates pre-authorizations; routes to departments as needed.
• Collects demographic, insurance, and clinical information to meet reimbursement requirements.
• Notifies necessary parties within required timeframes for routine and urgent requests.
• Monitors utilization to ensure cost-effective use through processing prior authorizations.
• Communicates with patients and/or referring physicians on non-covered benefits or coverage issues.
• Assists with medical necessity documentation to expedite approvals and follow-up.
• Records authorization documentation in the patient’s records and supports payer communication.

Skills

Interpersonal skills

Verbal and written communication

Time management

Teamwork

Cultural sensitivity

Critical thinking

Education

High School diploma or GED

Bachelor’s degree

Tools

Anthem

Availity

Evicor

CoverMyMeds

Magellan

Job description

Keystone Advisors LLC in Matteson, IL is seeking a motivated Prior Authorization Specialist to join our team supporting a healthcare client. This hybrid role entails obtaining and processing prior authorization requests, coordinating calls, and entering data with providers and payers.

You will document communications, follow up on denials, and ensure timely approvals. Ideal candidates have knowledge of payer portals (Anthem, Availity, Evicor, CoverMyMeds, Magellan) and strong written and spoken