Pre-Authorization Specialist II (Full-Time)

The Iowa Clinic•West Des Moines, IA

About The Position

The Pre-Authorization Specialist II is responsible for managing complex and high-priority pre-authorization requests for procedures, exams, and medications. This role requires advanced knowledge of insurance requirements, CPT/ICD coding, and payer policies. Specialist II serves as a resource for team members, handles escalated cases, and ensures compliance with regulatory and payer guidelines while maintaining exceptional accuracy and timeliness.

Requirements

High school diploma or equivalent required.
Minimum 2-3 years of experience in pre-authorization, medical billing, or related healthcare field.

Nice To Haves

Certification in medical billing/coding (e.g., CPC) preferred.

Responsibilities

Handles appeals, peer-to-peer requests, and negotiates with payers on complex or high-dollar denials.
Maintains advanced knowledge of CPT codes, ICD diagnosis codes, and payer-specific approval criteria.
Audits charts for compliance and accuracy, identifies trends in missing documentation.
Challenges insurance companies professionally when pre-authorizations are unjustly denied.
Provides guidance and training to Pre-Authorization Specialist I staff.
Maintains positive relationships with insurance company personnel and efficiently works through obtaining pre-authorizations through contact with them when necessary, including participating in the insurance-initiated nurse review process.
Promotes a positive, professional image of The Iowa Clinic, both externally and internally.
Maintains compliance with HIPAA and all regulatory requirements as well as confidentiality of financial information.

Benefits

One of the best 401(k) programs in central Iowa, including employer match and profit sharing
Employee incentives to share in the Clinic’s success
Generous PTO accruals
and paid holidays
Health, dental and vision insurance
Quarterly volunteer opportunities through a variety of local nonprofits
Training and development programs
Opportunities to have fun with your colleagues, including TIC night at the Iowa Cubs, employee appreciation tailgate party, Adventureland day, State Fair tickets, annual holiday party, drive-in movie night… we could go on and on
Monthly departmental celebrations, jeans days and clinic-wide competitions
Employee rewards and recognition program
Health and wellness program with up to $350/year in incentives
Employee feedback surveys
All employee meetings, team huddles and transparent communication