Skip to main content
Tallo logoTallo logo

Find Jobs

Find Jobs Near You – Available Work in Your Location

Skip to job details
Apply for this opportunity

To apply for this job, you'll continue to an external website or email application.

Jersey Community Hospital

Prior Authorization Specialist

Career Insights for Medical Claims Processor / Representative

See where this job fits in the broader career landscape. Knowing your career path helps you see what's possible from here.

Scorecard

Based on Illinois data

Review key factors to help you decide if this role fits your goals. How is this calculated?

Were these scores useful?

What they do

A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.

$45,566 / year median in Illinois

-7% projected decline

Explore Career

Job Description

Description:
Contact insurance carriers to verify patient's insurance eligibility, benefits, and authorization requirement. Secure prior authorizations before services are performed. Communicate insurance changes/trends to team and leadership. Document all communications/contacts with providers and other personnel. Prioritize time sensitive authorizations. Maintain proficiency in multiple EMR systems for demographics, insurance, and clinical information. Demonstrate proficiency in digital faxing, scanning, and instant messaging communication tools. Other roles and responsibilities as assigned.
Requirements:
Education and Experience:
High school graduate or equivalency. Certification through NAHAM, HFMA, AHIMA and Associates Degree preferred Minimum of two years' experience in a clinic/hospital billing, prior authorization, and/or insurance verification area, w/demonstrated payer knowledge preferred.
Skills/Abilities:
Demonstrated communication and customer service skills. Ability to follow oral or written instructions. Ability to organize and interpret data; judgment, tact, diplomacy and the ability to problem solve. Work effectively in a team environment; communicate with a variety of professionals Knowledge of computers and software required
Physical Requirements:
Work is of light demand.
Benefits:
Health Insurance Dental Insurance Vision Insurance Life Insurance Retirement Paid Time Off Tuition Reimbursement Health Savings Account Wellness Program Employee Assistance Program