Prior Authorization Representative

Avera•Le Mars, IA

5d•Onsite

About The Position

Floyd Valley Healthcare is seeking a full-time Centralized Authorization Representative to join their award-winning team in Le Mars, IA. This position is responsible for obtaining prior authorization from insurers for medical tests, procedures, and surgeries. The ideal candidate will have a medical field degree and/or 2+ years of medical experience with a strong understanding of medical terminology. Floyd Valley Healthcare offers a positive culture that supports a healthy work-life balance and is committed to being an employer of choice.

Requirements

Degree in the medical field and/or 2+ years working in a medical environment.
Strong understanding of medical terminology.
General computer knowledge is required.

Nice To Haves

Knowledge in ICD-10 and CPT is preferred.
Previous prior authorization and coding experience is preferred.
Mandatory Reporter training certificate a plus; certification is required as an employee.

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 Local Coverage Determination (LCD) if needed.
Appropriately document prior authorization and communicate information to performing facility, physician, clinic staff and patient can/or patient’s family as necessary.
Utilization of electronic medical record to efficiently process required prior authorizations and communication with in the organization.
Communication with Nurse Manager and/or RN status of denials and appeals.
Assist in the coordination of medical records retrieval to support appeal process.