Preadmissions Representative - Outpatient Services

Sioux Center Health; Sioux Center (IA); On-site; USD 42,000 - 64,000; Full time

Job summary

Sioux Center Health in Sioux Center, IA is seeking a Preadmissions Representative to schedule appointments, surgeries and procedures as directed by physicians, and to determine eligibility for payors by facilitating LCDs and obtaining prior authorizations. Must be a graduate of an accredited nursing program; knowledge of ICD-10/CPT coding is preferred.

Bi-lingual experience is a plus, though not required. The role requires collaboration with physicians, hospital departments, and insurers to

Qualifications

• Must be a graduate of an accredited school of nursing.
• Knowledge in ICD-10 and CPT coding preferred.
• Bi-lingual experience preferred but not required.

Responsibilities

• Schedules appointments, surgeries and procedures for patients as directed by physicians.
• Determines eligibility for all applicable payors by obtaining prior authorizations and LCDs.
• Documents prior authorizations and communicates information to performing facility, physician, clinic staff, patient and family as necessary.
• Demonstrates rapport and cooperation with physician offices, hospital departments, physicians and coworkers.
• Provides timely information to the supervisor regarding scheduling, staffing and customer service.
• Acts as a resource to assist non-licensed staff in problem solving, medical terminology and non-covered services.
• Assists with collection, sharing and maintenance of records and orders per Sioux Center Health guidelines.
• Demonstrates knowledge of health care technology and information management systems related to scheduling and prior authorizations.
• Coordinates the plan of care for patients by communicating treatment plans with applicable entities.
• Educates patients prior to procedures or tests per Sioux Center Health guidelines.
• Performs general clerical duties related to scheduling and communications.

Skills

Scheduling

Prior authorization

ICD-10/CPT coding knowledge

Communication skills

Bi-lingual (preferred)

Education

Nursing degree

Job description

Location: Sioux Center, IA Worker Type: Regular Work Shift: Day Shift (United States of America) Discover a Career of Faith and Healing: For over 70 years, Sioux Center Health has served patients with Jesus’ healing ministry. With eight locations located in Sioux Center, Iowa and surrounding communities, we take great pride in providing superior care in our state-of-the-art facilities. A Career that You Will Love: There’s no other way to say it: You will love working here. Between our strong mission and our great people, we have nurtured a pretty exceptional culture at Sioux Center Health. A Chance to Make a Difference: Working with us means making a real difference in the lives of our community members. Your talents and your passions are truly appreciated here. In addition to the service we provide, Sioux Center Health also supports our community with sponsored programs and events, and other volunteer work. If this is your passion, you need to consider joining our team driven to provide quality care and services within a caring Christian culture.

Position Highlights

At Sioux Center Health, our people are the heart of everything we do. Guided by a strong mission and a commitment to exceptional care, we've built a stable, thriving organization where employees make a meaningful difference. Our dedication to excellence is reflected in the recognition we have earned. Sioux Center Health has been named a Top Workplace in Iowa, received Best of the Northwest honors in 13 categories—including Best Place to Work—and earned a Five-Star Patient Survey Rating from the Centers for Medicare & Medicaid Services (CMS). We have also been recognized as a Chartis Top 100 Critical Access Hospital and Top Hospital in Iowa. Our Care Center has received the LeadingAge Excellence in Workplace Award, reflecting our commitment to creating a positive environment for both residents and employees. Beyond our organization, you'll find an outstanding community to call home. Sioux County was ranked #4 in the nation among the Healthiest Communities by U.S. News & World Report and CVS Health, reflecting the high quality of life and strong community values that make this region a great place to live, work, and grow.

Summary

The Preadmissions Representative is responsible for scheduling appointments, surgeries and procedures for patients as directed by the physicians. Also responsible for determining eligibility for all applicable payors by facilitating and overseeing Local Coverage Determinations (LCDs) as well as obtaining timely prior authorization from insurers for medical tests, procedures, surgeries and specialty appointments ordered by the provider.

General Hours of Work

Monday through Friday, call-in extra as needed

Education and/or Experience

Must be a graduate of an accredited school of nursing. Knowledge in ICD-10 and CPT coding preferred. General computer knowledge required. Bi-lingual experience preferred but not required.

Certificate, Licenses, Registrations

Must have current Iowa license to practice as a Licensed Practical Nurse or Registered Nurse.

Essential Functions

• Assists the supervisor in the maintaining of the Centralized Scheduling module.
• Obtains information from physician offices for scheduling tests, procedures and admissions in an accurate, timely and sequential manner.
• Determines eligibility for all applicable payors by obtaining prior authorizations 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 documents prior authorization and communicates information to performing facility, physician, clinic staff, and patient and/or patient’s family as necessary.
• Demonstrates good rapport, continual education updates and cooperative working relationships with physician office staff, all hospital departments, physicians and co-workers.
• Provides timely information to the supervisor regarding the scheduling process, staffing, customer service (physician office staff, all hospital departments, physicians and co-workers).
• Serves as a resource to assist non-licensed staff in problem solving, medical necessity, non-covered service and medical terminology.
• Assists with collection, sharing and maintenance of records and orders per Sioux Center Health guidelines.
• Demonstrates technological knowledge and skills sufficient to integrate the use of health care technology and/or information management systems as it pertains to scheduling and prior authorizations.
• Facilitates in coordinating a plan of care for patients by communicating plans of treatment with all applicable entities.
• Educates patients prior to procedures or tests according to the established guidelines of the Sioux Center Health.
• General clerical duties to include, but not limited to ordering supplies, making copies, faxing documents, greeting, answering/ monitoring phones, making appointments, and relaying messages.
• Performs other duties and responsibilities as assigned.

At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.