Prior Authorization Specialist - Healthcare (Day Shift)

Floyd Valley Healthcare; Le Mars (IA); On-site; USD 25,000 - 39,000; 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 hiring a full-time Centralized Authorization Department Representative to determine insurance payor eligibility and obtain prior authorizations for medical tests, procedures and surgeries.

You will document approvals in the EMR, communicate updates to facilities and clinicians, support appeals when needed, and coordinate medical records retrieval, all while upholding patient confidentiality and the organization’s commitment to compassionate, high-quality

Qualifications

• ICD-10 and CPT knowledge preferred.
• At least 1 year of healthcare experience.
• Prior authorization and coding experience preferred.
• General computer knowledge required.
• Mandatory Reporter training certificate a plus; certification is required as an employee.

Responsibilities

• Determine eligibility for payors by obtaining prior authorization from insurers for tests, procedures and surgeries.
• Document prior authorizations and communicate results to the performing facility, physician, clinic staff and patient/family as necessary.
• Utilize electronic medical records to efficiently process required prior authorizations and communicate within the organization.
• Communicate with Nurse Manager/RN regarding denials and appeals status.
• Assist in coordinating medical records retrieval to support the appeal process.

Skills

ICD-10 knowledge

CPT knowledge

Healthcare experience

Computer literacy

Tools

EMR systems

Job description

Floyd Valley Healthcare in Le Mars, IA is hiring a full-time Centralized Authorization Department Representative to determine insurance payor eligibility and obtain prior authorizations for medical tests, procedures and surgeries.

You will document approvals in the EMR, communicate updates to facilities and clinicians, support appeals when needed, and coordinate medical records retrieval, all while upholding patient confidentiality and the organization’s commitment to compassionate, high-quality