Prior Authorization Specialist: Fast, Accurate Approvals

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

Job summary

Carle Health in Illinois is seeking a Pre-Authorization Specialist to identify prior auth requirements and process authorizations for scheduled and add-on services. You will determine coverage, document in Epic, and communicate outcomes to the care team to minimize denials.

The role requires a high school diploma or GED, basic English skills, and strong communication. You will work with payer portals, doctors, and nurses to gather necessary information and improve authorization turnaround.

Qualifications

• Education: Highschool Diploma or GED.
• Basic reading, writing and oral skills required.
• Strong communication and professional demeanor.
• Ability to handle confidential information with discretion.

Responsibilities

• Analyze information required to complete pre-authorizations based on payer requirements and ensure correct coverage.
• Proficiently use payer portals to process pre-authorization submissions and know provider expectations.
• Document results and communicate approvals or denials to leadership and care teams; advocate for patients.
• Collaborate with physicians and nurses to obtain clinical information for submissions.
• Identify challenges and trends; work with management to address and resolve.
• Other duties as assigned; manage scheduled and add‑on pre-auths as needed.

Skills

Basic reading

Basic writing

Basic oral skills

Effective communication

Confidential information handling

Professional demeanor

Education

Highschool Diploma or GED

Tools

Epic

Windows OS

Microsoft Word

Spreadsheets (Excel)

Email applications

Web browser

Job description

Carle Health in Illinois is seeking a Pre-Authorization Specialist to identify prior auth requirements and process authorizations for scheduled and add-on services. You will determine coverage, document in Epic, and communicate outcomes to the care team to minimize denials.

The role requires a high school diploma or GED, basic English skills, and strong communication. You will work with payer portals, doctors, and nurses to gather necessary information and improve authorization turnaround.