Prior Authorization Specialist
Ann & Robert H. Lurie Children's Hospital of Chicago
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Streeterville, IL
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Mid-Senior level
Posted March 4, 2026
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Responsibilities
Responsibilities
- Interprets and obtains data for medical necessity and precertification compliance; calculates, explains, and collects patient liabilities; and completes third-party eligibility and benefit verification in order to ensure compliance with government/regulatory and third-party payer requirements, and to ensure prompt and accurate billing and payment of hospital accounts receivable.
- Ensures pre-certifications are completed prior to visit for all scheduled appointments.
- Manages precertification cases for outpatient surgery, admission authorizations, radiology, sleep studies, and referrals for office visits.
- Maintains current knowledge of insurance requirements, benefit provisions and pre-certification.
- Contacts patient and/or division teams to provide updates on precertification status and timeliness.
- Generates patient estimates and contacts patient to provide details on patient financial responsibility.
- Updates patient’s registration information as needed.
- Consistently meets quality and productivity requirements.
- Other job functions as assigned.
Not Met Priorities
What still needs stronger evidence
Requirements
- Excellent communication/listening skills.
- Demonstrates knowledge of utilization management process including communication with payors and benefit authorization for applicable situations.
- Experience reviewing medical charts/records and abstracting relevant clinical data to support medical necessity of scheduled procedures.
- Minimum two years’ experience in pre-certification initiation in a hospital/facility setting or physician office environment working precertification for inpatient, outpatient, outpatient surgery and admissions.
- Knowledge of medical terminology, third party billing, utilization management and managed care requirements.
- Proficient computer skills and aptitude.
- Substantial interpersonal skills sufficient to work effectively with pediatric patients, families, physicians, nursing and other allied health and medical center personnel.
- Problem solving ability and able to handle multiple priorities.
Education
- (Required) – High school graduate required; BS or BA preferred.
- (Not required) – Education
- (Required) – High School Diploma/GED (Required)
Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.
Day (United States of America)
Location
680 Lake Shore Drive
Job Description
General Summary:
The Financial Clearance I secures required precertification/prior authorizations for ambulatory, inpatient, outpatient surgery, and admissions cases. Interprets and obtains data for medical necessity and precertification compliance; calculates, explains, and collects patient liabilities; and completes third-party eligibility and benefit verification in order to ensure compliance with government/regulatory and third-party payer requirements, and to ensure prompt and accurate billing and payment of hospital accounts receivable.
Essential Job Functions
Ensures pre-certifications are completed prior to visit for all scheduled appointments.
Manages precertification cases for outpatient surgery, admission authorizations, radiology, sleep studies, and referrals for office visits.
Maintains current knowledge of insurance requirements, benefit provisions and pre-certification.
Contacts patient and/or division teams to provide updates on precertification status and timeliness.
Generates patient estimates and contacts patient to provide details on patient financial responsibility.
Updates patient’s registration information as needed.
Consistently meets quality and productivity requirements.
Other job functions as assigned.
Knowledge, Skills And Abilities
High school graduate required; BS or BA preferred.
Excellent communication/listening skills.
Demonstrates knowledge of utilization management process including communication with payors and benefit authorization for applicable situations.
Experience reviewing medical charts/records and abstracting relevant clinical data to support medical necessity of scheduled procedures.
Minimum two years’ experience in pre-certification initiation in a hospital/facility setting or physician office environment working precertification for inpatient, outpatient, outpatient surgery and admissions.
Knowledge of medical terminology, third party billing, utilization management and managed care requirements.
Proficient computer skills and aptitude.
Substantial interpersonal skills sufficient to work effectively with pediatric patients, families, physicians, nursing and other allied health and medical center personnel.
Problem solving ability and able to handle multiple priorities.
Education
High School Diploma/GED (Required)
Pay Range
$19.50-$30.23 Hourly
At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs. For more details on other compensation, consult your recruiter or click the following link to learn more about our benefits.
Benefit Statement
Benefits
For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:
Medical, dental and vision insurance
Employer paid group term life and disability
Employer contribution toward Health Savings Account
Flexible Spending Accounts
Paid Time Off (PTO), Paid Holidays and Paid Parental Leave
403(b) with a 5% employer match
Various Voluntary Benefits
Supplemental Life, AD&D and Disability
Critical Illness, Accident and Hospital Indemnity coverage
Tuition assistance
Student loan servicing and support
Adoption benefits
Backup Childcare and Eldercare
Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
Discount on services at Lurie Children’s facilities
Discount purchasing program
There’s a Place for You with Us
At Lurie Children’s, we embrace and celebrate building a team with a variety of backgrounds, skills, and viewpoints — recognizing that different life experiences strengthen our workplace and the care we provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care.
Lurie Children’s and its affiliates are equal employment opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law.
Support email: peoplequestions@luriechildrens.org
Day (United States of America)
Location
680 Lake Shore Drive
Job Description
General Summary:
The Financial Clearance I secures required precertification/prior authorizations for ambulatory, inpatient, outpatient surgery, and admissions cases. Interprets and obtains data for medical necessity and precertification compliance; calculates, explains, and collects patient liabilities; and completes third-party eligibility and benefit verification in order to ensure compliance with government/regulatory and third-party payer requirements, and to ensure prompt and accurate billing and payment of hospital accounts receivable.
Essential Job Functions
Ensures pre-certifications are completed prior to visit for all scheduled appointments.
Manages precertification cases for outpatient surgery, admission authorizations, radiology, sleep studies, and referrals for office visits.
Maintains current knowledge of insurance requirements, benefit provisions and pre-certification.
Contacts patient and/or division teams to provide updates on precertification status and timeliness.
Generates patient estimates and contacts patient to provide details on patient financial responsibility.
Updates patient’s registration information as needed.
Consistently meets quality and productivity requirements.
Other job functions as assigned.
Knowledge, Skills And Abilities
High school graduate required; BS or BA preferred.
Excellent communication/listening skills.
Demonstrates knowledge of utilization management process including communication with payors and benefit authorization for applicable situations.
Experience reviewing medical charts/records and abstracting relevant clinical data to support medical necessity of scheduled procedures.
Minimum two years’ experience in pre-certification initiation in a hospital/facility setting or physician office environment working precertification for inpatient, outpatient, outpatient surgery and admissions.
Knowledge of medical terminology, third party billing, utilization management and managed care requirements.
Proficient computer skills and aptitude.
Substantial interpersonal skills sufficient to work effectively with pediatric patients, families, physicians, nursing and other allied health and medical center personnel.
Problem solving ability and able to handle multiple priorities.
Education
High School Diploma/GED (Required)
Pay Range
$19.50-$30.23 Hourly
At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs. For more details on other compensation, consult your recruiter or click the following link to learn more about our benefits.
Benefit Statement
Benefits
For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:
Medical, dental and vision insurance
Employer paid group term life and disability
Employer contribution toward Health Savings Account
Flexible Spending Accounts
Paid Time Off (PTO), Paid Holidays and Paid Parental Leave
403(b) with a 5% employer match
Various Voluntary Benefits
Supplemental Life, AD&D and Disability
Critical Illness, Accident and Hospital Indemnity coverage
Tuition assistance
Student loan servicing and support
Adoption benefits
Backup Childcare and Eldercare
Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
Discount on services at Lurie Children’s facilities
Discount purchasing program
There’s a Place for You with Us
At Lurie Children’s, we embrace and celebrate building a team with a variety of backgrounds, skills, and viewpoints — recognizing that different life experiences strengthen our workplace and the care we provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care.
Lurie Children’s and its affiliates are equal employment opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law.
Support email: peoplequestions@luriechildrens.org