Prior Approval Specialist – Medical Assistance Consultant II

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Prior Approval Specialist for the Illinois Department of Healthcare and Family Services handling durable medical equipment approvals. Seeking motivated candidate with strong communication and problem-solving skills.

Posted 6/5/2026full-timeSpringfield • Illinois • 🇺🇸 United StatesJuniorMid-Level💰 $5,572 - $7,898 per monthWebsite

About the role

Key responsibilities & impact

Conducts professional work in the interpretation of Department policies, procedures, instructions, in the prior approval process for durable medical equipment and specialized medical services
Provides a current status of prior approval requests within the MMIS database to providers of these services
Responds to telephone and/or written correspondence to/from medical vendors, agency staff, and the general public regarding inquiries, complaints, and requests for information and assistance
Researches and analyzes prior approval requests submitted by medical providers to determine action for entering prior approvals
Stays up to date on policy and procedure changes
Attends meetings
Performs other duties as required or assigned

Requirements

What you’ll need

Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college with courses in medical social work
Requires two (2) years professional experience in fields related to medical social work
Licensure in one of the following specialties: Registered Nurse, Speech-Language Pathologist, Respiratory Therapist, Physical Therapist, or Occupational Therapist (Preferred)
Three (3) years of experience working with medical terminology (Preferred)
One (1) year of experience working with federal, state and local legislation and agency requirements pertinent to public assistance, medical care and rehabilitation assistance (Preferred)
One (1) year of experience providing consultation and instruction related to professional and medical social casework (Preferred)
One (1) year of experience providing customer service to medical provider offices on behalf of a payer (Preferred)
One (1) year of experience addressing policies and procedural inquiries from providers, interest groups and the general public (Preferred)

Benefits

Comp & perks

Health, Life, Vision, and Dental Insurance
Pension Plan
Paid Parental Leave
Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
(12) paid Sick Days annually
(10) paid Vacation Days first year (up to 25 annually)
(3) paid Personal Days annually
(13-14) paid holidays annually (based on start date)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical social workmedical terminologyprior approval processconsultationinstructioncustomer servicepolicy interpretationprocedure analysislegislation knowledgecasework

Soft Skills

communicationanalytical skillsproblem-solvinginterpersonal skillsorganizational skills

Certifications

Registered NurseSpeech-Language PathologistRespiratory TherapistPhysical TherapistOccupational Therapist