Prior Authorization Specialist – Epic, Clinical Office Experience

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

📋 Description

• Provide telephonic assistance for the online authorization of standard services

• Liaise with specialty care providers concerning authorizations, denials, and appeals

• Oversee patient eligibility and confirm authorization requirements for ongoing services

• Execute online authorization requests and data entry for routine authorizations and denials

• Act as the department authority on prior authorizations

• Collaborate with QA, HCC, Administration, Clinical, Patients, Families, and Billing Teams

• Process and communicate the completion of patient accounts/orders that require insurance verification, prior authorization, and/or pre-certification

• Collect information for clinical staff to assess the need for continued services

• Educate and serve as a resource for both clinical and non-clinical departments

• Identify and report potential quality management concerns

• Accurately enter required information into relevant systems

• Utilize diagnosis, HCPCS, revenue, and CPT coding

• Complete communication tasks, respond to inquiries, participate in staff meetings, and review communications with employees

• Carry out additional duties as assigned by the Manager

⛳️ Requirements

• Epic experience is essential

• Clinical Office experience is required

• Familiarity with diagnosis coding, HCPCS, revenue, and CPT coding

• Capability to perform telephonic and online authorization requests

• Ability to verify patient eligibility and authorization prerequisites

• Proficient data entry into relevant systems

• Capacity to meet deadlines and productivity/performance standards

• Consistent and regular attendance is required

• Adherence to OSHA, accreditation standards, risk management guidelines, personnel policies, and corporate compliance policies

• Professional demeanor when interacting with the public, patients, families, and payors

🏝️ Benefits

• Comprehensive benefits package for team members and providers

• Option for remote work

• Day shift availability

• Monday-Friday work schedule

• No weekend obligations

• No holiday commitments

• No on-call duties