Prior Authorization Specialist - Patient Services

Carle Health; Normal (IL); On-site; USD 25,000 - 39,000; Full time

Job summary

Carle Health is seeking a Prior Authorization Specialist to ensure accurate and timely prior authorizations for procedures, medications, and insurance verifications. The role involves handling denials, processing appeals, and coordinating peer-to-peer discussions, with a backup to patient service representatives.

You will collaborate with providers, nurses, insurance reps, and billing staff to resolve issues, educate teams on payer criteria, and maintain EMR documentation related to

Qualifications

• Insurance authorization experience required.

Responsibilities

• Serves as the department expert for prior authorizations.
• Assists department leadership to optimize and implement current prior authorization workflow, procedures, documentation, and communication.
• Educates and communicates with providers and clinical staff regarding payer criteria to facilitate patient treatment plans and payment of services.
• Collaborates with clinical integration and endocrinology team to standardize EMR documentation for authorizations.

Skills

Insurance authorization

Job description

Carle Health is seeking a Prior Authorization Specialist to ensure accurate and timely prior authorizations for procedures, medications, and insurance verifications. The role involves handling denials, processing appeals, and coordinating peer-to-peer discussions, with a backup to patient service representatives.

You will collaborate with providers, nurses, insurance reps, and billing staff to resolve issues, educate teams on payer criteria, and maintain EMR documentation related to