Prior Authorization Specialist

Prior Authorization Specialist

The Prior Authorization Specialist is responsible for obtaining prior authorization for provider practices, which may include outpatient services, specialty care and other ancillary services. The Prior Authorization Specialist verifies insurance coverage and gathers clinical information to ensure that all reimbursement requirements are met.

Who We Are

Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers who provide compassionate, comprehensive care for our patients and the communities we serve.

What You Can Expect

• Flexible position, work from home 2 days, in person (Munster, IN) 3 days.
• Monday through Friday 8:00am to 5:00pm.
• Training will be 1 month on site (Munster, IN).
• Serve as primary contact, educator, and resource for all ambulatory department prior authorization requirements and processes.
• Collect clinical and coding information regarding services to be rendered.
• Contact payer to obtain prior authorization.
• Provide standardized documentation within EPIC to identify prior authorization and the criteria surrounding such authorization; stay informed and research information regarding insurance criteria for prior authorization.
• Verify standard documentation and requirements have been met, and advise providers and their clinical staff when issues arise relating to obtaining prior authorization.

Qualifications

• Required High School Diploma/GED
• 1 year Prior Authorizations and Revenue Cycle Required

Travel is required: Never or Rarely

Equal Opportunity Employer

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity.