Cook County Health and Hospitals
PRIOR AUTHORIZATION SPECIALIST
Cook County Health and Hospitals, Chicago, Illinois, United States, 60290
Job Posting:
Nov 15, 2024, 9:53:29 PM Closing Date:
Nov 30, 2024, 5:59:00 AM Full-time Shift Start Time:
8:00 A.M. Shift End Time:
4:00 P.M. Collective Bargaining Unit:
NONE Posting Salary:
$76,194-$86,292 Organization:
Health and Hospital Systems LOCATION:
MATTESON, IL DEPARTMENT:
FINANCE-REVENUE CYCLE SHIFT:
8:00 AM- 4:00 PM JOB SUMMARY:
The Prior Authorization Specialist is responsible for obtaining and processing all prior authorization requests, coordinating phone calls, entering and tracking data from insurance providers and health plans regarding authorization, expedited reviews, and appeals. The Prior Authorization Specialist is required to document and track all communication attempts with insurance providers and health plans, follow up on all denials while working to ensure services are validated. TYPICAL DUTIES: Reviews accounts, initiates pre-authorizations, and routes to appropriate departments as needed. Collects demographic, insurance, and clinical information to ensure that all reimbursement requirements are met. Notifies 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. Communicates with patients and/or referring physicians on non-covered benefits or procedure coverage issues. Assists with medical necessity documentation to expedite approvals. Provides consistent and comprehensive information to facilitate approvals. Ensures insurance carrier documentation requirements are met. Appeals pre-authorization denials and/or sets up peer-to-peer reviews. Maintains an extensive working knowledge of insurance companies and billing authorization requirements. Identifies and reports undesirable trends and reimbursement modeling errors. Builds and maintains working relationships with staff, referral sources, insurance companies, and medical providers. MINIMUM QUALIFICATIONS: 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, Availty, Evicor, Covermymeds, Magellan. PREFERRED QUALIFICATIONS: Knowledge and experience with payer processes to submit appropriate clinical documentation. Experience using Medical Terminology. KNOWLEDGE, SKILLS, ABILITIES AND OTHER CHARACTERISTICS: 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 diverse patient population. Strong time management skills to prioritize assignments and meet deadlines. Ability to anticipate, recognize, and meet the needs of patients and their families. Ability to work in a team-based environment. Ability to demonstrate respect and sensitivity for cultural diversity. Ability to critically think, problem solve, and make independent decisions supporting the authorization process. BENEFITS PACKAGE: Medical, Dental, and Vision Coverage. Basic Term Life Insurance. Pension Plan and Deferred Compensation Program. Employee Assistance Program. Paid Holidays, Vacation, and Sick Time. You may also qualify for the Public Service Loan Forgiveness Program (PSLF). For further information on our excellent benefits package, please click on the following link:
Cook County Benefits VETERAN PREFERENCE: When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service. To take advantage of this preference a Veteran must: Meet the minimum qualifications for the position. Identify self as a Veteran on the employment application by answering yes to the question, "Are you a Military Veteran?" Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation) at the time of application filing. COOK COUNTY HEALTH & HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
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Nov 15, 2024, 9:53:29 PM Closing Date:
Nov 30, 2024, 5:59:00 AM Full-time Shift Start Time:
8:00 A.M. Shift End Time:
4:00 P.M. Collective Bargaining Unit:
NONE Posting Salary:
$76,194-$86,292 Organization:
Health and Hospital Systems LOCATION:
MATTESON, IL DEPARTMENT:
FINANCE-REVENUE CYCLE SHIFT:
8:00 AM- 4:00 PM JOB SUMMARY:
The Prior Authorization Specialist is responsible for obtaining and processing all prior authorization requests, coordinating phone calls, entering and tracking data from insurance providers and health plans regarding authorization, expedited reviews, and appeals. The Prior Authorization Specialist is required to document and track all communication attempts with insurance providers and health plans, follow up on all denials while working to ensure services are validated. TYPICAL DUTIES: Reviews accounts, initiates pre-authorizations, and routes to appropriate departments as needed. Collects demographic, insurance, and clinical information to ensure that all reimbursement requirements are met. Notifies 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. Communicates with patients and/or referring physicians on non-covered benefits or procedure coverage issues. Assists with medical necessity documentation to expedite approvals. Provides consistent and comprehensive information to facilitate approvals. Ensures insurance carrier documentation requirements are met. Appeals pre-authorization denials and/or sets up peer-to-peer reviews. Maintains an extensive working knowledge of insurance companies and billing authorization requirements. Identifies and reports undesirable trends and reimbursement modeling errors. Builds and maintains working relationships with staff, referral sources, insurance companies, and medical providers. MINIMUM QUALIFICATIONS: 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, Availty, Evicor, Covermymeds, Magellan. PREFERRED QUALIFICATIONS: Knowledge and experience with payer processes to submit appropriate clinical documentation. Experience using Medical Terminology. KNOWLEDGE, SKILLS, ABILITIES AND OTHER CHARACTERISTICS: 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 diverse patient population. Strong time management skills to prioritize assignments and meet deadlines. Ability to anticipate, recognize, and meet the needs of patients and their families. Ability to work in a team-based environment. Ability to demonstrate respect and sensitivity for cultural diversity. Ability to critically think, problem solve, and make independent decisions supporting the authorization process. BENEFITS PACKAGE: Medical, Dental, and Vision Coverage. Basic Term Life Insurance. Pension Plan and Deferred Compensation Program. Employee Assistance Program. Paid Holidays, Vacation, and Sick Time. You may also qualify for the Public Service Loan Forgiveness Program (PSLF). For further information on our excellent benefits package, please click on the following link:
Cook County Benefits VETERAN PREFERENCE: When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service. To take advantage of this preference a Veteran must: Meet the minimum qualifications for the position. Identify self as a Veteran on the employment application by answering yes to the question, "Are you a Military Veteran?" Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation) at the time of application filing. COOK COUNTY HEALTH & HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
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