PRIOR AUTHORIZATION SPECIALIST

The final salary and offer components are subject to additional approvals based on Cook County Health (CCH) policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at CCH. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement.

LOCATION: MATTESON, IL

DEPARTMENT: FINANCE-REVENUE CYCLE

SHIFT: 8:00 AM- 4:00 PM

JOB SUMMARY NON-UNION

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, 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.

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, Magellang

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 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 CCH 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

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: http://www.cookcountyrisk.com/

VETERAN PREFERENCE
PLEASE READ

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 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 time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable

OR
* A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.

If items are not attached, you will not be eligible for Veteran Preference

VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.

MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.

*Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U. S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents bust be presented at time of interview.

*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.

*CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.

COOK COUNTY HEALTH & HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER