Centralized Prior Authorization Representative

Sioux Center Health; Le Mars (IA); On-site; USD 42,000 - 58,000; Full time

Benefits offered by this job

Student Debt Program

IPERS Retirement

Medical Insurance

Dental Insurance

Vision Insurance

FSA

Short-Term Disability

Long-Term Disability

Life Insurance

Fitness Center

Paid Time Off

Competitive pay

Job summary

Floyd Valley Healthcare in Le Mars, IA is seeking a Centralized Authorization Department Representative to join our award-winning team. This full-time role (40 hours weekly) focuses on obtaining prior authorizations from insurers, documenting them, and communicating results to care teams.

The position offers a supportive culture and regular daytime hours. Responsibilities include determining eligibility for payors, obtaining authorizations, using EMR systems, and coordinating with nurses and

Qualifications

• Minimum 1 year of healthcare experience.
• Knowledge of ICD-10 and CPT preferred.
• Prior authorization and coding experience preferred.

Responsibilities

• Determine eligibility for payors by obtaining prior authorization from insurers for tests, procedures, surgeries and LCD as needed.
• Document prior authorizations and communicate results to facilities, physicians, clinics and patients.
• Utilize EMR to process required authorizations and communicate within the organization.
• Communicate with Nurse Manager/RN about denials and appeals; assist in retrieving medical records for appeals.
• Hours are Monday-Friday, 8:00 am-4:30 pm.

Skills

ICD-10 knowledge

CPT knowledge

Prior authorization

Healthcare coding

Computer skills

Mandatory Reporter

Job description

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, 8:0 am-4:30 pm.

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.