Prior Authorization Specialist – Epic, Clinical Office Experience

Carle Health

Prior authorization specialist processing insurance approvals, denials, and eligibility for Carle Health, an Illinois healthcare provider. Supporting clinical teams and patients through accurate coding, authorization, and account processing.

Posted 8/12/2026full-timeRemote • Illinois • 🇺🇸 United StatesMid-LevelSenior💰 $18 - $29 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in telephonic and online authorization processes, including patient eligibility verification and coding practices such as HCPCS and CPT. Collaborates effectively with clinical and non-clinical teams while ensuring compliance with relevant standards and policies.

Highest-signal resume keywords

Epic ExperienceClinical Office ExperienceDiagnosis CodingTelephonic Authorization RequestsData Entry Accuracy

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Diagnosis CodingHCPCS CodingCPT CodingData EntryPatient Eligibility Verification

Soft Skills

Professional ConductCollaborationCommunication

Tools & Technologies

Epic Systems

Industry Keywords

Prior AuthorizationInsurance VerificationQuality ManagementOSHA ComplianceAccreditation Standards

About the role

Key responsibilities & impact

Perform telephonic support for online authorization of routine services
Contact specialty care providers regarding authorizations, denials, and appeals
Monitor patient eligibility and verify authorization needs for continued services
Perform online authorization requests and data entry for routine authorizations and denials
Serve as department expert for prior authorizations
Collaborate with QA, HCC, Administration, Clinical, Patients, Families, and Billing Teams
Process and communicate completion of patient accounts/orders requiring insurance verification, prior authorization, and/or pre-certification
Gather information for clinical staff to determine continued services
Educate and act as a resource to clinical and non-clinical departments
Identify and report potential quality management issues
Enter required information accurately into applicable systems
Use diagnosis, HCPCS, revenue, and CPT coding
Complete communication tasks, respond to messages, attend staff meetings, and review employee communications
Perform other duties requested by the Manager

Requirements

What you’ll need

Must have Epic experience
Must have Clinical Office experience
Experience with diagnosis coding, HCPCS, revenue, and CPT coding
Ability to perform telephonic and online authorization requests
Ability to verify patient eligibility and authorization requirements
Accurate data entry into applicable systems
Ability to meet deadlines and productivity/performance measures
Regular and consistent attendance
Compliance with OSHA, accreditation standards, risk management guidelines, personnel policies, and corporate compliance policies
Professional conduct when dealing with the public, patients, families, and payors

Benefits

Comp & perks

Comprehensive benefits package for team members and providers
Remote work arrangement
Day shift
Monday-Friday schedule
No weekend requirements
No holiday requirements
No on-call requirements