Prior Authorization Specialist

Overview

Under the direct supervision of the manager, performs assigned duties, including telephonic support for on-line authorization of routine services, contacting specialty are providers, monitoring patient eligibility, and performing on-line data entry of routine authorizations / denials.

Qualifications

Certifications : , Education : , Work Experience :

Responsibilities

Serves as department expert for prior authorizations

Establishes effective rapport and work closely with QA, HCC, Administration, Clinical, Patients, Families, and Billing Teams to ensure that all patients have authorization for services performed.

Contacts providers with authorization, denial and appeals process as applicable.

Verifies eligibility and authorization needs of current patients for continued services.

Works from spreadsheets in determining authorization needs.

Performs telephonic and on-line authorization requests for our services.

Identifies, processes, and communicates the completion of all department patient accounts / orders that require insurance verification, prior authorization, and / or pre-certification in a timely manner

Assists in gathering information needed for clinical staff to determine continued services.

Assists in educating and acts as a resource to clinical and non-clinical departments.

Assists with the identification and reporting of potential quality management issues.

Accurately enter required information into all applicable systems.

Uses Diagnosis Coding, HCPCS, Revenue and CPT coding.

Meets specified deadlines as required for continued patient satisfaction.

Demonstrates a professional image in dealing with the public, patients, families and payors.

Maintains regular and consistent attendance at work.

Behaves in a manner consistent with Mission, Vision, Values and Expectations for Excellence.

Maintains compliance with OSHA, Accreditation Standards and Risk Management guidelines.

Maintains compliance with Personnel policies and procedures.

Behaves in a manner consistent with all Corporate Compliance policies and procedures.

Meets measures as determined and required for job productivity and performance improvement.

Completes communication tasks and activities in a timely manner. This would include, but is not limited to : responding to email, voicemail or telephone messages, promptly, accurately, and professionally; attending staff meetings as scheduled or viewing videotapes of those meetings; asking questions of team members and supervisors when needing clarification about various day-to-day issues or patient needs; and reviewing employee communication pieces.

Performs other duties as requested by the Manager

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 : human.resources@carle.com.

Compensation and Benefits

The compensation range for this position is $16.98per hour - $27.51per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model.

Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org / benefits.