Prior Authorization Specialist — Healthcare Benefits Pro

Comunidade Metodista; Matteson (IL); On-site; USD 52,000 - 64,000; 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

401K with company match

Life Insurance

Job summary

Keystone Advisors in Matteson, IL seeks a Prior Authorization Specialist to obtain and process prior authorization requests, coordinate communications, and maintain documentation with health plans. You will track denials and work to validate services and expedite approvals within a team-focused environment.

Responsibilities include collecting patient data, navigating insurance portals, and coordinating with physicians and staff to ensure timely authorizations and compliant records.

Qualifications

• High school diploma or GED with 5 years of prior authorization experience, or Bachelor's with 2 years of prior authorization experience.
• Three (3) years of experience processing insurance requests to obtain prior authorization.
• Experience using insurance portals (Anthem, Availity, Evicor, CoverMyMeds, Magellan).

Responsibilities

• Reviews accounts and initiates pre-authorizations and related requirements; routes to appropriate departments.
• Collects demographic, insurance and clinical information to meet reimbursement requirements.
• Notifies parties within required timeframes for routine and urgent requests.
• Monitors utilization to assure cost-effective use of medical resources 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.
• Provides clear information to facilitate approvals.
• Ensures insurer documentation requirements are met and records updated.
• Appeals pre-authorization denials and/or arranges peer-to-peer reviews.
• Maintains knowledge of insurance payer requirements and billing authorization standards.
• Builds relationships with staff, referral sources, insurers and medical providers.

Skills

Microsoft Office

Interpersonal skills

Verbal communication

Written communication

Time management

Team player

Cultural sensitivity

Education

High School diploma or GED

Bachelor's degree

Tools

Anthem portal

Availity

Evicor

CoverMyMeds

Magellan

Job description

Keystone Advisors in Matteson, IL seeks a Prior Authorization Specialist to obtain and process prior authorization requests, coordinate communications, and maintain documentation with health plans. You will track denials and work to validate services and expedite approvals within a team-focused environment.

Responsibilities include collecting patient data, navigating insurance portals, and coordinating with physicians and staff to ensure timely authorizations and compliant records.