Preadmissions Representative - Therapy Center

Avera•Sioux Center, IA

10d

About The Position

The Preadmissions Representative determines eligibility for applicable payors by overseeing Local Coverage Determinations (LCDs) and obtaining timely prior authorizations from insurers for therapy center procedures. The role also provides scheduling coverage as needed and performs therapy center aide duties. General hours are Monday through Friday, with call-in work as needed. The position supports therapy center departments, particularly wound care, lymphedema, and diabetes education. It involves communicating authorization and scheduling information with patients, families, providers, clinic staff, and hospital departments, maintaining records and orders, and using healthcare technology and information management systems.

Requirements

General computer knowledge.
Knowledge of ICD-10 and CPT coding is preferred.
At least two years of healthcare experience and/or coding certification is recommended.
Bilingual experience is preferred but not required.

Nice To Haves

Knowledge of ICD-10 and CPT coding.
Bilingual experience.

Responsibilities

Determine eligibility for applicable payors by obtaining required insurer prior authorizations and addressing Local Coverage Determinations (LCDs).
Document prior authorizations and communicate relevant information to the performing facility, provider, clinic staff, and patient or family as needed.
Obtain information, including written or verbal physician orders, from physician offices to schedule tests, procedures, and admissions accurately and in a timely, sequential manner.
Maintain cooperative working relationships with provider office staff, hospital departments, physicians, and coworkers, and pursue continual education updates.
Provide the supervisor with timely information regarding prior authorization processes, staffing, and customer service.
Assist with collecting, sharing, and maintaining records and orders according to Sioux Center Health guidelines.
Use healthcare technology and information management systems as they relate to prior authorizations.
Perform clerical duties such as copying, faxing, and completing tracking and paperwork for therapy center departments, particularly wound care, lymphedema, and diabetes education.
Cover therapy center scheduling as needed, including answering and monitoring phones, scheduling appointments, and relaying messages.
Perform therapy aide tasks, including cleaning and organizing rooms, and complete other assigned tasks.
Perform other duties and responsibilities as assigned.