Insurance Pre-Authorization Specialist (Orthopedics)

　　Department: Orthopedics - Sports Med1048

　　Entity: Champaign-Urbana Service Area

　　Job Category:

　　Employment Type: Full - Time

　　Job ID: 38275

　　Experience Required: 1 - 3 Years

　　Education Required: Not Indicated

　　Shift: Day

　　Location: Urbana, IL

　　Usual Schedule: Monday-Friday 8:00am-5:00pm

　　On Call Requirements: None

　　Work Location: Orthopedics & Sports Medicine

　　Weekend Requirements: None

　　Holiday Requirements: None

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　　Position Summary:

　　The Insurance Pre-Authorization Specialist is responsible for processing submissions for insurance prior authorizations (PA) and coordinating any denials follow up, as indicated.

　　Qualifications:

　　EDUCATIONAL REQUIREMENTS None Specified CERTIFICATION & LICENSURE REQUIREMENTS Completion of a Medical Terminology course required within one year of hire. EXPERIENCE REQUIREMENTS One (1) year Healthcare or One (1) year Health Insurance experience required.

　　SKILLS AND KNOWLEDGE Strong verbal and written communication skills. PC and data entry skills. Epic competency preferred but not required. Demonstrated ability to organize and prioritize work and possess attention to detail. Ability and willingness to work in a clinical environment and closely with nurses and physicians. Demonstrated ability to working independently. Must be able to apply critical thinking skills and apply specific departmental policies related to insurance pre-authorization submissions and denial follow up.

　　Essential Functions:

　　Analyzes information required to complete pre- authorizations with insurance carriers and governmental payors.

　　Obtains necessary information to accurately process pre-authorization requests.

　　Utilizes third party payer/insurance portals to process PA submissions; has a detailed knowledge of insurance providers, their portals and their expectations for authorization approval.

　　Advocates for patients/providers by processing PA's in a time sensitive manner and collaborating, as indicated with physicians and nurses, to accurately secure clinical information to support the PA submission.

　　Cross-trains to support additional office/scheduling functions as deemed necessary for optimal business operations.

　　Coordinates any denial follow-up, as indicated

　　Process FMLA/Disability Paperwork

　　We are an Equal Opportunity Employer and 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. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected].

　　Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.