Patient Services Representative, Prior Authorization Specialist – CWP Endocrinology

Carle Health

. Ensure accurate and timely prior authorization of procedures, medications, and insurance verifications .

Posted 10/12/2026full-timeNormal • Illinois • United StatesMid-LevelSenior💰 $18 - $29 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in prior authorization processes, including insurance verifications, appeals, and ICD/CPT coding. Capable of optimizing workflows and collaborating with clinical teams to ensure accurate documentation and communication.

Highest-signal resume keywords

Prior Authorization ExpertiseICD and CPT Coding KnowledgeInsurance Verification ProcessingWorkflow OptimizationCollaboration with Clinical Teams

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior AuthorizationInsurance VerificationICD CodesCPT CodesAppeals ProcessingDenial ManagementPatient Account ManagementDocumentation MaintenanceEMR StandardizationPatient Coverage Validation

Soft Skills

Attention to DetailIndependent WorkEffective CommunicationPrioritization SkillsOrganizational Skills

Tools & Technologies

Payer WebsitesEMR SystemsFax CommunicationPhone Systems

Certifications & Qualifications

Employment Authorization VerificationForm I-9E-Verify

Industry Keywords

Endocrinology ServicesClinical IntegrationPeer-to-Peer ReviewsThird-Party DeadlinesPatient Services

About the role

Key responsibilities & impact

Ensure accurate and timely prior authorization of procedures, medications, and insurance verifications
Reverse denials, process appeals, and coordinate peer-to-peer discussions
Serve as the department expert for prior authorizations
Optimize and implement prior authorization workflows, procedures, documentation, and communication
Research LCDs, NCDs, formulary lists, and insurance criteria for endocrinology services
Educate and communicate with providers and clinical staff regarding authorization requirements
Maintain organized authorization information and documentation
Collaborate with clinical integration and endocrinology teams to standardize EMR documentation
Serve as the primary patient resource regarding the prior authorization process
Process patient accounts and orders requiring insurance verification, prior authorization, or pre-certification
Validate patient coverage, benefits, and eligibility
Initiate authorization requests via payer websites, fax, and phone
Submit accurate ICD and CPT codes and related medical records
Maintain authorization documentation and follow up on requests
Communicate authorization issues and status to providers, staff, and patients
Verify and document third-party authorization responses in the EMR
Resolve delayed or denied requests by gathering information, submitting appeals, or escalating issues
Serve as departmental billing liaison for patients and UPH CBO
Reconcile daily patient charges and estimate patient costs
Resolve claims and denials related to prior authorization
Manage the patient account work queue and correct billing issues with providers, CBO representatives, and coding teams
Serve as backup patient services representative
Answer phones, schedule appointments, maintain work queues, register patients, and check patients in and out
Complete other duties assigned by the supervisor

Requirements

What you’ll need

Work experience in insurance authorization
Ability to navigate and maneuver through multiple websites
Ability to complete work with a high level of detail and accuracy
Ability to work efficiently and independently
Ability to prioritize authorizations based on patient needs and department procedure schedules
Knowledge of ICD and CPT codes and related medical records
Ability to process insurance verifications, prior authorizations, pre-certifications, denials, appeals, and peer-to-peer reviews
Ability to work with providers, nurses, insurance representatives, financial advocates, coding teams, and patient account representatives
Ability to meet specified third-party deadlines
Ability to answer phones, schedule appointments, maintain work queues, register patients, and check patients in and out
Participation in employment authorization verification through Form I-9 and E-Verify

Benefits

Comp & perks

Comprehensive benefits package
Equal opportunity employment
Potential for growth and life-long careers