Centralized Prior Authorization Representative

Avera•Le Mars, IA

1d•Onsite

About The Position

Floyd Valley Healthcare is hiring a full-time Centralized Authorization Representative in Le Mars, Iowa. This regular position is scheduled for 40 hours per week, Monday through Friday, from 8:00 a.m. to 4:30 p.m. The representative obtains prior authorizations from insurers for medical tests, procedures, surgeries, and other services as required by a patient's insurance carrier or Local Coverage Determination (LCD). The role also involves documenting authorizations, communicating with facilities, clinicians, patients and families, and supporting denials and appeals. The position is part of a healthcare organization that describes its workplace as positive and fulfilling and emphasizes work-life balance. Floyd Valley Healthcare's mission is to be a progressive healthcare partner serving with compassion, integrity and excellence.

Requirements

At least 1 year of healthcare experience.
General computer knowledge is required.
Mandatory Reporter certification is required as an employee.

Nice To Haves

Knowledge of ICD-10 and CPT.
Previous coding experience.
Previous prior authorization experience.
Mandatory Reporter training certificate is a plus.

Responsibilities

Determine eligibility with applicable payors and obtain prior authorizations for medical tests, procedures, surgeries, and other services required by the patient's insurance carrier or Local Coverage Determination (LCD).
Document prior authorizations appropriately and communicate relevant information to the performing facility, physician, clinic staff, patient, and/or patient's family as necessary.
Use the electronic medical record to process required prior authorizations and communicate within the organization.
Communicate the status of denials and appeals to the Nurse Manager and/or RN.
Assist with coordinating retrieval of medical records to support the appeals process.