Pre-Authorization Specialist- A - Carle Foundation Hospital : Job Details

Overview 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. Qualifications EDUCATIONAL REQUIREMENTS None Required CERTIFICATION & LICENSURE REQUIREMENTS Completion of Medical Terminology course within one (1) year of start date in position. EXPERIENCE REQUIREMENTS Healthcare/Insurance experience of one (1) + year preferred SKILLS AND KNOWLEDGE Strong verbal and written communication skills. Adept at learning and using software programs is essential. Demonstrated ability to organize and prioritize work and possess a strong attention to detail and follow up with minimal direction/supervision. Ability to work and collaborate with patients, nurses and physicians under stressful situations. Able to work independently and apply critical thinking skills when dealing with insurance scenarios for various payers. Able to navigate multiple payer websites to ensure requirements are met. Ability to handle large volume of pre-auths and multi task concurrently. Responsibilities 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. About Us Find it here. Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health. Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn 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. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. 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 or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected].