Carle Health
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.
Prior Authorization Specialist – Epic, Clinical Office Experience
🔥 0 minutes ago
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Carle Health
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
• Perform telephonic support for online authorization of routine services • Contact specialty care providers regarding authorizations, denials, and appeals • Monitor patient eligibility and verify authorization needs for continued services • Perform online authorization requests and data entry for routine authorizations and denials • Serve as department expert for prior authorizations • Collaborate with QA, HCC, Administration, Clinical, Patients, Families, and Billing Teams • Process and communicate completion of patient accounts/orders requiring insurance verification, prior authorization, and/or pre-certification • Gather information for clinical staff to determine continued services • Educate and act as a resource to clinical and non-clinical departments • Identify and report potential quality management issues • Enter required information accurately into applicable systems • Use diagnosis, HCPCS, revenue, and CPT coding • Complete communication tasks, respond to messages, attend staff meetings, and review employee communications • Perform other duties requested by the Manager
🎯 Requirements
• Must have Epic experience • Must have Clinical Office experience • Experience with diagnosis coding, HCPCS, revenue, and CPT coding • Ability to perform telephonic and online authorization requests • Ability to verify patient eligibility and authorization requirements • Accurate data entry into applicable systems • Ability to meet deadlines and productivity/performance measures • Regular and consistent attendance • Compliance with OSHA, accreditation standards, risk management guidelines, personnel policies, and corporate compliance policies • Professional conduct when dealing with the public, patients, families, and payors
🏖️ Benefits
• Comprehensive benefits package for team members and providers • Remote work arrangement • Day shift • Monday-Friday schedule • No weekend requirements • No holiday requirements • No on-call requirements
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