[Hiring] Pre-Authorization Specialist @Carle Health

Role Description

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.

• 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.

Qualifications

• Education: Highschool 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.

Benefits

• The compensation range for this position is $18 per hour - $29.13 per hour.
• Carle Health offers a comprehensive benefits package for team members and providers.

Company Description

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.

• 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 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.
• We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.