Pre-Authorization Specialist
4 days ago
The Pre-Authorization Specialist is a critical role at Carle Health, responsible for ensuring seamless patient care by managing prior authorizations for scheduled and add-on services. This position requires strong analytical and communication skills, as well as the ability to navigate complex insurance and payer requirements.
Key Responsibilities- Pre-Authorization Analysis: Analyze information required to complete pre-authorizations based on multiple insurance/payer requirements, ensuring coverage and insurance accuracy.
- Insurance Portal Management: Proficiently utilize third-party payer/insurance portals to process pre-auth submissions, with a detailed knowledge of insurance providers, their portals, and expectations for authorization approval.
- Documentation and Communication: Document pre-authorization results completely and communicate to leadership, providers, and/or nurses pre-authorization approvals or denials.
- Patient Advocacy: Advocate for patients/providers by processing pre-auths in a timely manner and collaborating with physicians and nurses to secure clinical information needed for submissions.
- Process Improvement: Identify challenges, trends, and patterns and work with management to address and resolve.
- Education: Associates degree or NAHAM Certification
- Experience: Healthcare/Insurance experience of one (1) + year preferred
- Skills: Strong verbal and written communication skills, adept at learning and using software programs, ability to organize and prioritize work, and a strong attention to detail.
We are committed to creating a diverse and inclusive work environment that values and respects all employees and applicants. We 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.
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