Pre-Authorization Specialist – Insurance Portal Experience

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Identify prior authorization requirements set by insurance/payer.

• Process and finalize prior authorizations for both scheduled and add-on services.

• Assess whether services fall under covered benefits.

• Record pre-authorization details and outcomes in Epic.

• Relay approvals or denials to ordering provider offices, leadership, providers, and nursing staff.

• Manage pre-authorizations promptly to minimize denials.

• Collaborate with physicians and nurses to gather clinical information for submissions.

• Coordinate peer-to-peer reviews when necessary.

• Recognize challenges, trends, and patterns, and collaborate with management to address them.

• Carry out other assigned tasks as needed.

⛳️ Requirements

• High School Diploma or GED.

• Experience with direct insurance portals.

• Proficient in using third-party payer/insurance portals for pre-authorization submissions.

• In-depth understanding of insurance providers, their portals, and authorization approval criteria.

• Basic reading skills in English.

• Basic writing skills in English.

• Basic oral communication skills in English.

• Ability to respond appropriately to customers and colleagues.

• Capability to interact with a diverse range of individuals.

• Ability to maintain confidentiality of sensitive information.

• Ability to communicate only factual information to recipients or choose not to disclose certain details.

• Ability to present a professional, friendly, and helpful demeanor.

• Basic computer skills, including familiarity with word processing, spreadsheets, email applications, and web browsers.

• Comfortable using Windows OS and learning new software applications.

• Availability to work Monday through Friday, from 8:00 a.m. to 5:00 p.m. Central Time.

🏝️ Benefits

• Comprehensive benefits package.

• Equal Opportunity Employer.

• Participation in E-Verify.