Prior Authorization Specialist

• 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

Explore Patient Services Representative, Prior Authorization Specialist… at Carle Health. Review requirements and application details.

Prior Authorization Specialist jobs in Illinois

Patient Services Representative, Prior Authorization Specialist – CWP Endocrinology