Clinical Insurance Authorization Specialist - Spencer Hospital
Avera•Spencer, IA
•Onsite
About The Position
Spencer Hospital is a rural hospital located in northwest Iowa employing over 500+ employees. Positions at Spencer Hospital are not affiliated with Avera; however, we collaborate to provide services to the communities we serve. Employment offers, if accepted, are exclusively with Spencer Hospital. Spencer Hospital offers competitive wages, affordable insurance, IPERS retirement, in-house education, paid time off, family gym membership and so much more!
Requirements
- Current, active Licensed Practical Nurse (LPN) license in Iowa or an active multi‑state license through the Nurse Licensure Compact (NLC).
- Must be eligible to practice in Iowa.
- Prior hospital and/or clinical authorization experience preferred.
- Must uphold high ethical standards.
- Exhibit poise and tact when working with staff, physicians, and other members of the healthcare team.
- Excellent oral communication skills and the ability to interact with customers in a professional manner are essential.
- Must be adaptable and flexible in moving between various functions based on workload demand.
- Must have excellent organizational skills.
Responsibilities
- Coordinate with staff in order to complete prior authorization for all services and procedures in an accurate and timely manner.
- Ensure that all supporting documentation is available and shared with payers to expedite authorizations.
- Maintaining authorizations, which includes gathering necessary documents to support authorization requests, submitting initial requests for authorization, following up on authorization requests, and communicating with departments and providers on status of authorizations.
- Coordinate with providers as needed to ensure treatments/services meet medical necessity criteria.
- Assist with appeals for claim denials due to the authorization process.
- Develop and implement prior authorization workflow, policies and procedures.
- Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner.
- Share information with providers and staff regarding coverage criteria, medically necessary criteria.
Benefits
- affordable insurance
- IPERS retirement
- in-house education
- paid time off
- family gym membership
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
