Prior Authorization Specialist

Job Summary

Keystone Advisors is looking for a Prior Authorization Specialist to join our team in Matteson, IL supporting one of our healthcare clients.

• Reviews accounts, and initiate pre-authorizations, and other requirements related to managed care; route to appropriate departments as needed.
• Collects demographic, insurance, and clinical information to ensure that all reimbursement requirements are met.
• Notifies the necessary parties within the required timeframe for routine and urgent requests for services.
• Assists in monitoring utilization services to assure cost effective use of medical resources through processing prior authorizations.
• Communicates with patients and/or referring physicians on non-covered benefits or procedure coverage issues.
• Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Provides consistent and comprehensive information (both in writing and verbally) to facilitate approvals.
• Ensures insurance carrier documentation requirements are met and authorization documentation is entered and recorded in the patient’s records.
• Appeals pre-authorization denials and/or set-up peer to peer reviews.
• Maintains an extensive working knowledge and expertise of insurance companies and billing authorization requirements.
• Identifies and reports undesirable trends and reimbursement modeling errors or underlying causes of incorrect payment; review allowed variances from third party payers.
• Builds and maintains working relationships with staff, referral sources, insurance companies, and medical providers.

• High School diploma or GED equivalent with five (5) years of prior authorization experience OR Bachelor’s degree with two (2) years of prior authorization experience
• Three (3) years of experience processing insurance requests to obtain prior authorization
• Experience and familiarity with using insurance portals, i.e., Anthem, Availity, Evicor, Covermymeds, Magellan

• Knowledge and experience with payer processes to submit appropriate clinical documentation
• Experience using Medical Terminology

• Proficiency with Microsoft applications and internet-based programs
• Strong interpersonal skills with the ability to establish strong working relationships
• Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
• Strong time management skills to prioritize assignments and meet the designated deadline
• Ability to anticipate, recognize, and meet the needs of the patients and their families
• Ability to work in a team-based environment to accomplish goals and objectives
• Ability to demonstrate respect and sensitivity for cultural diversity in client’s work force and patient population
• Ability to critically think, problem solve and make independent decisions supporting the authorization process, including interactions with payer representatives, physicians, and hospital case managers

• Competitive Salary
• Paid Time Off
• Health, Vision & Dental Insurance
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Short & Long Term Disability
• 401 (K) with company match
• Life Insurance