Pre-Authorization Specialist – Direct Insurance Portal Experience

Carle Health

. Identify prior authorization requirements by insurance/payer .

Posted 10/14/2026full-timeRemote • Illinois • United StatesMid-LevelSenior💰 $18 - $29 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing prior authorizations and navigating insurance portals, while effectively communicating with healthcare providers and maintaining patient confidentiality. Proficient in documenting information in Epic and advocating for timely approvals.

Highest-signal resume keywords

Prior Authorization ProcessingInsurance Portal ExperienceEpic DocumentationPatient AdvocacyCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization RequirementsInsurance Coverage DeterminationThird-Party Payer KnowledgeBasic Computer KnowledgeWindows OS Proficiency

Soft Skills

Professional DemeanorInterpersonal SkillsConfidentiality MaintenanceCustomer InteractionTime-Sensitive Processing

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Insurance ProvidersAuthorization Approval ExpectationsPeer-to-Peer ReviewsClinical Information CollaborationTrends and Patterns Identification

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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