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Insurance Verification and Prior Authorization Specialist

Insurance Verification and Prior Authorization Specialist

USA Clinics GroupNorthbrook, IL, US
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Why USA Clinics Group?

Founded by Harvard-trained physicians with a vision of offering patient-first care beyond the hospital settings, we’ve grown into the nation’s largest network of outpatient vein, fibroid, vascular, and prostate centers, with 170+ clinics across the country. Our mission is simple : deliver life-changing, minimally invasive care, close to home.

We’re building a culture where innovation, compassion, and accountability thrive. While proud of our growth, we’re even more excited about what’s ahead, and the team we’re building to get there. We look forward to meeting you!

Why You'll Love Working with us :

🚀 Rapid career advancement           💼 Competitive compensation package

🤝 Positive, team-oriented environment  🏥 Work with cutting-ed technology

🌟 Make a real impact on patients’ lives  📈 Join a fast-growing, mission-driven company

Position Details :

  • Location : Northbrook corporate office (not remote)
  • Full time
  • Compensation : $22-$28 / hr

USA Clinics Group is looking for an organized and motivated individual to join the team as our newest Insurance Verification / Prior Authorization Specialist ! This position performs the function of obtaining referrals, and / or authorizations prior to the service date for test, procedures, and admissions into the clinics.

Responsibilities :

  • Reviews referring physician and patient documentation for Medical Necessity against insurance protocol requirements for pre-certification purposes
  • Actively communicates with staff regarding status if authorization. Communicates the need for reschedule and / or cancellation if authorization not in-hand
  • Directs liaison to offices and patients regarding new, changed, or pending insurance authorizations, as well as on-going education of changes in authorization requirements
  • Work on 20+ denials per day, investigating and finding solutions in a timely manner
  • Responsible for scheduling STAT, emergent patients for outpatient diagnostic exams
  • Interacts with patients, their representatives, physicians, physician office staff, and others to gather and ensure accuracy of demographic, billing and clinical information
  • Produces and distributes required forms with accurate patient information
  • Respects and protects the patient’s rights to confidentiality and privacy and discloses information only for the professional purposes which are in the patient’s best interests with full consideration of their legal rights
  • Displays a positive attitude when interacting with provider’s office staff, providers and fellow employees

    • Requirements

  • At least 2 years of prior experience in a health care setting handling benefit verification and prior authorizations
  • Knowledge about referrals and able to locate / contact PCP offices
  • High volume of insurance verification and authorization submissions
  • Immaculate attention to detail and excellent proofreading skills
  • High school diploma
  • Billing and Coding or other related certifications preferred

    • Benefits

  • Insurance : health, vision, and dental
  • Paid training
  • PTO & sick time
  • 401k option
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    Prior Authorization Specialist • Northbrook, IL, US