Pre-Authorization Spec

Carle Health•Champaign, IL

18h

About The Position

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.

Requirements

Certifications:
Education:
Work Experience:

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.
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.
Other duties as assigned.