Senior Pre-Authorization Specialist

LAKE REGION HEALTHCARE CORPORATION•Fergus Falls, MN

6d•$24 - $33•Onsite

About The Position

The Senior Pre-Authorization Specialist facilitates the gathering of information to verify medical necessity and meet prior authorization and insurance referral requirements. The role reviews and processes prior authorization and external referral requests, coordinates authorization and referral information across providers, clinics, and hospital departments, and supports revenue cycle initiatives. The position is located at Lake Region Healthcare Corporation in Fergus Falls, Minnesota, and is scheduled for 80 hours biweekly, Monday through Friday on day shifts.

Requirements

An LPN credential or a two-year healthcare degree is required.
Ability to communicate proficiently and professionally verbally and in writing.
Must be able to attend the work site according to the schedule.
Successful completion of the pre-employment health screening process is required.

Nice To Haves

Experience or knowledge of authorizations, referrals, verifications, CPT and ICD-10 coding, and the medical claims process is desired.

Responsibilities

Review and process prior authorization and external referral requests.
Gather required clinical documentation and apply payer-specific guidelines and medical necessity criteria.
Communicate with insurance companies and providers regarding authorization status and outcomes.
Escalate cases for physician review when necessary.
Coordinate and communicate authorization and referral information with providers, clinics, and hospital departments.
Ensure required orders and notifications are completed before scheduled procedures.
Collaborate with clinical teams to meet documentation requirements.
Assist Revenue Cycle Leadership with projects related to denial management, tracking, and new service line development.