Prior Authorization Specialist: Streamlined Approvals

Carle; Champaign, Northern (IL, KY); Hybrid; USD 25,000 - 40,000; Full time

Job summary

Carle Health in Champaign, IL is seeking a Pre-Authorization Specialist to identify prior auth requirements and process authorizations for scheduled and add-on services. You will document results in Epic and communicate with ordering Providers to minimize denials and support peer-to-peer reviews as needed.

The role requires a Highschool Diploma or GED and basic English skills. You will work with physicians, nurses, and care teams to ensure timely submissions while maintaining patient

Qualifications

• Education: Highschool Diploma or GED.
• Basic English skills including reading, writing and speaking.
• Ability to respond appropriately to customer and co-worker interactions.
• Professional demeanor and ability to maintain confidentiality.

Responsibilities

• Analyze information to complete pre-authorizations based on insurance requirements.
• Use payer portals to process pre-auth submissions and understand provider expectations.
• Document pre-authorization results and communicate with leadership, providers, and nurses.
• Collaborate with physicians and nurses to obtain needed information for submissions.
• Identify trends and issues and work with management to resolve them.
• Process pre-authorizations for scheduled and add-on services.

Skills

Basic reading skills

Basic writing skills

Basic oral skills

Communication skills

Computer skills

Education

Highschool Diploma or GED

Tools

Windows OS

Word processing

Spreadsheet

Email client

Web browser

Job description

Carle Health in Champaign, IL is seeking a Pre-Authorization Specialist to identify prior auth requirements and process authorizations for scheduled and add-on services. You will document results in Epic and communicate with ordering Providers to minimize denials and support peer-to-peer reviews as needed.

The role requires a Highschool Diploma or GED and basic English skills. You will work with physicians, nurses, and care teams to ensure timely submissions while maintaining patient