Pre-Authorization Specialist – Direct Insurance Portal Experience

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $18 - $29 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔒 Insurance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Carle Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

🏥 Healthcare

📚 Education

Healthcare Insurance • Healthcare • Education

Carle Health is a comprehensive healthcare provider dedicated to managing the health needs of its community. Offering a wide range of services, from general medical care to specialized treatments in oncology, cardiovascular, pediatrics, and women's health, Carle Health emphasizes quality patient care and community health initiatives. Additionally, it supports education and research through the Carle Illinois College of Medicine and engages in community health programs that aim to improve overall well-being.

📋 Description

• Identify prior authorization requirements by insurance/payer • Process and complete prior authorizations for scheduled and add-on services • Determine whether services are covered benefits • Document pre-authorization information and results in Epic • Communicate approvals or denials to leadership, providers, nurses, and ordering provider offices • Advocate for patients and providers by processing authorizations in a time-sensitive manner • Collaborate with physicians and nurses to obtain clinical information for submissions • Identify challenges, trends, and patterns and work with management to resolve them • Facilitate peer-to-peer reviews when needed • Perform other duties as assigned

🎯 Requirements

• High school diploma or GED • Direct insurance portal experience • Proficiency with third-party payer/insurance portals • Detailed knowledge of insurance providers, their portals, and authorization approval expectations • Basic English reading, writing, and oral skills • Ability to respond appropriately to customers and co-workers • Ability to interact with a wide variety of people • Ability to maintain confidential information • Ability to communicate only facts to recipients or decline to reveal information • Professional, friendly, and helpful demeanor • Basic computer knowledge, including word processing, spreadsheets, email applications, and web browsers • Comfortable with Windows OS and learning new applications

🏖️ Benefits

• Comprehensive benefits package • Equal Opportunity Employer • Potential for growth and life-long careers