Prior Authorization Pro: Epic & Payer Expert

Carle Health; Champaign (IL); On-site; USD 25,000 - 40,000; Full time

Benefits offered by this job

Benefits package

Job summary

Carle Health is seeking a Pre-Authorization Specialist to identify insurance requirements and complete prior authorizations for scheduled and add-on services. You will determine if services are covered, document results in Epic, and communicate approvals or denials to the ordering Provider's office.

In this role, you will collaborate with physicians, nurses, and leadership to reduce denials, ensure timely submissions, and provide patient advocacy throughout the authorization process.

Qualifications

• High school diploma or GED required.
• Basic English skills: reading, writing, speaking.
• Strong communication skills with co-workers and customers.
• Basic computer skills and Windows OS familiarity.

Responsibilities

• Identify prior authorization requirements by insurance/payer and process authorizations for scheduled and add-on services.
• Determine coverage and document pre-authorization information in Epic; communicate results to leadership, Providers, and/or Nurses.
• Advocate for patients/providers by timely pre-auth submissions and collaborating with physicians/nurses to obtain necessary clinical information.

Skills

English

Communication skills

Computer skills

Windows OS basics

Education

High school diploma or GED

Job description

Carle Health is seeking a Pre-Authorization Specialist to identify insurance requirements and complete prior authorizations for scheduled and add-on services. You will determine if services are covered, document results in Epic, and communicate approvals or denials to the ordering Provider's office.

In this role, you will collaborate with physicians, nurses, and leadership to reduce denials, ensure timely submissions, and provide patient advocacy throughout the authorization process.