Centralized Prior Authorization Representative

Floyd Valley; Le Mars (IA); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Student Debt Program

IPERS Retirement

Medical Insurance

Dental Insurance

Vision Insurance

Flexible Spending Account (FSA)

Short-term Disability Insurance

Long-term Disability Insurance

Life Insurance

Fitness Center

Paid Time Off

Competitive pay based on experience

Job summary

Floyd Valley Healthcare in Le Mars, IA seeks a Centralized Authorization Department Representative. This full-time role manages prior authorizations for medical tests, surgeries, and procedures, communicating results to physicians, clinics, and patients.

The position uses electronic medical records to process requests and coordinates with nursing leadership on denials and appeals. Ideal candidates have ICD-10 and CPT knowledge, at least 1 year of healthcare experience, and familiarity with payer

Qualifications

• Knowledge in ICD-10 and CPT is preferred; prior authorization experience beneficial.
• Minimum of 1 year of healthcare experience.

Responsibilities

• Determine eligibility for payors by obtaining prior authorization for tests, procedures, surgeries, and LCDs.
• Document prior authorizations and communicate results to facilities, physicians, clinics, and patients or families.
• Utilize electronic medical records to process required authorizations and communicate within the organization.
• Communicate with Nurse Manager and/or RN regarding denials and appeals; assist in medical records retrieval for appeals.

Skills

ICD-10 knowledge

CPT knowledge

Prior authorization

Coding experience

General computer skills

Job description

Centralized Prior Authorization Representative# Avera Careers## Centralized Prior Authorization RepresentativeApply: Le Mars, IA: Full time: Posted 2 Days Ago: R-260030862**Location:**Le Mars, IA**Worker Type:**Regular**Work Shift:**Day Shift (United States of America)Floyd Valley Healthcare is proud to offer a positive and fulfilling work environment that supports a healthy work-life balance. We understand that our employees have choices, and we strive to be an employer of choice for our team.**Position Highlights****Come join our award-winning team at Floyd Valley Healthcare as a Centralized Authorization Department Representative.**Floyd Valley Healthcare in Le Mars, IA has a full-time Centralized Authorization Representative position (40 hours per week). Floyd Valley offers a positive culture that supports a healthy work-life balance. Our Mission is to be a progressive healthcare partner serving with compassion, integrity and excellence. **Responsibilities:*** Determine eligibility for all applicable payors by obtaining prior authorization from insurers for medical tests, procedures, surgeries and any other prior authorizations required by the patient’s insurance carrier or Local Coverage Determination (LCD) if needed.* Appropriately document prior authorization and communicate information to performing facility, physician, clinic staff and patient can/or patient’s family as necessary.* Utilization of electronic medical record to efficiently process required prior authorizations and communication with in the organization.* Communication with Nurse Manager and/or RN status of denials and appeals. Assist in the coordination of medical records retrieval to support appeal process.* Hours are Monday-Friday, 8:00am-4:30pm.**Requirements**: * Knowledge in ICD-10 and CPT is preferred and previous coding experience preferred. With a minimum of 1 year of healthcare experience.* Previous prior authorization and coding experience is preferred.* General computer knowledge is required.* Mandatory Reporter training certificate a plus; certification is required as an employee**.** * **We are proud to offer:*** Student Debt Program* IPERS Retirement* Medical, Dental, and Vision insurance* Flexible Spending Account (FSA)* Short-term and Long-term Disability Insurance* Life Insurance* Fitness Center* Paid Time Off* Competitive pay based on experience * **About Floyd Valley Healthcare:** Floyd Valley Healthcare is a 25-bed critical access hospital and is located in Le Mars, Iowa, home of \"The Ice Cream Capital of the World!\" Floyd Valley Healthcare has had a rich history of serving the healthcare needs of people in Le Mars, Iowa and the surrounding communities. Today, Floyd Valley includes the hospital, family medicine clinics in Le Mars, Marcus and Remsen, and public health. We serve people in their homes through home health and home medical services. Floyd Valley Healthcare is licensed by the State of Iowa, affiliated with the Avera System of Sioux Falls, South Dakota and is a member of the Iowa and American Hospital Associations.*Pre-employment drug screen, background check, and employee health review including required immunizations are required. FVH participates in E-Verify.Floyd Valley Healthcare is an Equal Opportunity Employer committed to providing an environment of opportunities to all applicants and employees without regard to race, color, religion, marital status, age, national origin, physical or mental disability, pregnancy, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected by law.*