Keystone Advisors LLC · 2 weeks ago
Prior Authorization Specialist
Matteson, IL
Full-time
Onsite
Mid Level
3+ years expKeystone Advisors LLC is looking for a Prior Authorization Specialist to join their team in Matteson, IL, supporting one of their healthcare clients. The role involves obtaining and processing prior authorization requests, coordinating with insurance providers, and ensuring services are validated through effective communication and documentation.
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Responsibilities
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
Qualification
Required
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
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
Preferred
Knowledge and experience with payer processes to submit appropriate clinical documentation
Experience using Medical Terminology
Benefits
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
Company
Keystone Advisors LLC
Keystone Advisors of Illinois, LLC.
11-50 employees
H1B Sponsorship
Keystone Advisors LLC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2022 (1)
Funding
Current Stage
Early StageCompany data provided by crunchbase