Centralized Prior Authorization Representative

Sioux Center Health; Sioux Center (IA); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Student Debt Program

IPERS Retirement

Medical, Dental, and Vision insurance

Flexible Spending Account

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, Iowa invites applications for a full-time Centralized Authorization Representative. This role processes prior authorizations and coding tasks within our centralized authorization department. The position emphasizes accuracy, communication with care teams, and efficient use of the EMR system.

The successful candidate will have ICD-10/CPT knowledge, at least 1 year in healthcare, and comfortable with standard computer tools. Pre-employment screening is required.

Qualifications

• Knowledge of ICD-10 and CPT; prior coding experience preferred.
• Minimum 1 year of healthcare experience.
• General computer literacy required.

Responsibilities

• Determine eligibility for payors by obtaining prior authorizations for tests, procedures, surgeries and LCDs as needed.
• Document prior authorizations and communicate results to facilities, physicians, staff and patients.
• Utilize electronic medical records to process required authorizations and communicate within the organization.
• Coordinate with Nurse Manager/RN on denials and appeals; assist in obtaining medical records for appeals.
• Work Monday–Friday, 8:00 am–4:30 pm.

Skills

ICD-10

CPT coding

Healthcare experience

EMR proficiency

Tools

EMR system

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.