Pre-Authorization Spec - direct insurance portal

The Pre-Authorization Specialist is responsible for identifying prior auth requirements by insurance/payer and processes and completes prior authorizations for scheduled and add on services. Determines if services are a covered benefit and documents pre-authorization information in Epic. Communicates with the ordering Provider's office if services were approved or denied to reduce denials and facilitates peer to peer reviews when needed.

Education:

High school Diploma or GED

Work Experience:

Required English Skills
Basic reading skills
Basic writing skills
Basic oral skills

Communication Skills
Ability to respond appropriately to customer/co-worker
Interaction with a wide variety of people
Maintain confidential information
Ability to communicate only the facts to recipients or to decline to reveal information
Ability to project a professional, friendly, helpful demeanor

Computer Skills
Basic computer knowledge:
Uses word processing, spreadsheet, e-mail application, and web browser. Comfortable with Windows OS and learning new applications.

• Analyzes information required to complete pre-authorizations based on multiple insurance/payer requirements; ensures coverage/insurance is correct.
• Proficiently utilizes third party payer/insurance portals to process pre-auth submissions; has a detailed knowledge of insurance providers, their portals and expectations for authorization approval.
• Documents pre-authorization results completely and communicates to leadership, Providers and/or Nurses pre-authorization approvals or denials. Advocates for patients/providers by processing pre-auths in a time sensitive manner and collaborating with physicians and nurses to secure clinical information needed for submissions.
• Identifies challenges, trends and patterns and works with management to address and resolve.
• Other duties as assigned. Identifying prior auth requirements by insurance/payer and processes and completes prior authorizations for scheduled and add on services.
• Determines if services are a covered benefit and documents pre-authorization information in Epic.
• Communicates with the ordering Provider office
• if services were approved or denied to reduce denials and facilitates peer to peer reviews when needed.

Find it here.

Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.

Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College.

Carle Bro Menn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state…