Prior Authorization Specialist - Healthcare (Full-Time)

Avera; Le Mars (IA); On-site; USD 36,000 - 54,000; Full time

Benefits offered by this job

Student Debt Program

IPERS Retirement

Medical, Dental, and Vision insurance

Flexible Spending Account

Short-term and Long-term Disability

Life Insurance

Fitness Center

Paid Time Off

Competitive pay based on experience

Job summary

Floyd Valley Healthcare in Le Mars, IA is seeking a Centralized Authorization Department Representative for a full-time, day shift role. You will determine eligibility for payors, obtain prior authorizations, document communications, and support appeals using the EMR.

Hours are Monday–Friday, 8:00am–4:30pm. Ideal candidates have ICD-10/CPT knowledge and at least 1 year of healthcare experience, with prior authorization or coding experience preferred.

Qualifications

• Knowledge in ICD-10 and CPT is preferred and previous coding experience preferred.
• Minimum of 1 year of healthcare experience.
• General computer knowledge is required.

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 LCD if needed.
• Document prior authorization and communicate information to 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 and/or RN regarding denials and appeals; assist in coordinating medical records retrieval to support the appeal process.
• Hours are Monday-Friday, 8:00am-4:30pm.

Skills

ICD-10/CPT knowledge

Coding experience

General computer knowledge

Mandatory Reporter training

Job description

Floyd Valley Healthcare in Le Mars, IA is seeking a Centralized Authorization Department Representative for a full-time, day shift role. You will determine eligibility for payors, obtain prior authorizations, document communications, and support appeals using the EMR.

Hours are Monday–Friday, 8:00am–4:30pm. Ideal candidates have ICD-10/CPT knowledge and at least 1 year of healthcare experience, with prior authorization or coding experience preferred.