Role Description The Department of Healthcare and Family Services, Bureau of Professional and Ancillary Services is seeking to hire a motivated candidate to serve as a Prior Approval Reviewer. Under the direction of the Prior Approval and Customer Relations section manager, this position will serve as a specialized physician reviewer for the Medical Review Unit. The duties for this position may include but are not limited to: - Providing expert medical/clinical, consultative, program and policy advisory services related to specialized medical equipment and services to staff. - Convening regular meetings with staff to participate in developing, implementing and maintaining system changes or policy decisions that may impact medical services to individuals eligible for Medical Assistance. - Participating in developing medical criteria options for program coverage of durable medical equipment, supplies and other covered services. The ideal candidate will have strong communication skills, excellent team leadership skills, ability to thrive in a high volume and fast paced environment and demonstrate the ability to collaborate with team members to ensure operations are running effectively. Qualifications - Requires an Illinois license to practice medicine. Requirements - A minimum of two (2) years of experience making clinical prior approval decisions including, working with complex medical data, and familiarity with medical coding such as ICD-10CM, CPT or HCPCSs. - A minimum of two (2) years of professional experience communicating with medical providers on behalf of a payer regarding billing codes and rejection codes as well as medical terminology. - Requires two (2) years of experience working with Medical Management Information Systems (MMIS) or similar medical processing system. Benefits - Monday-Friday work schedule. - Flexible work schedules are available in many program areas. (Remote work may be an option for certain positions.) - Health, Life, Vision, and Dental Insurance. - Pension Plan. - Paid Parental Leave. - Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare). - Employees earn (12) paid Sick Days annually. - New Employees earn (10) paid Vacation Days their first year of service and can earn up to (25) paid Vacation Days annually. - Employees earn (3) paid Personal Days annually. - (13-14) paid holidays annually (based on start date). Company Description At the Illinois Department of Healthcare and Family Services (HFS), we value staff as our greatest asset. We work in a spirit of teamwork to help millions of Illinoisans access high quality healthcare and fulfill child support obligations to advance their physical, mental, and financial well-being. We provide healthcare coverage for children and adults through Medicaid and other medical programs, and we help ensure that children receive financial resources from both their parents through Child Support Services. The HFS Office of the Inspector General investigates, audits and reviews program activity to ensure the integrity of our programs is maintained. HFS is committed to promoting and preserving a workplace culture that embraces diversity, equity, and inclusion. We welcome and value employees with different backgrounds, life experiences, and talents. It is the collective sum of our individual differences that provides a broad perspective, leading to greater innovation and achievement. In recruiting for our team, we recognize the unique contributions of each applicant regardless of culture, ethnicity, race, national origin, sex, gender identity and expression, age, religion, disability, and sexual orientation. HFS is an equal opportunity employer.