The Pre-Authorization Specialist will facilitate the gathering of information to verify medical necessity to meet prior authorization and insurance referral requirements, as well as gather information for inpatient and swing bed stay approvals. Duties and responsibilities include but are not limited to:

• Receive and review requests from provider and determine if a prior authorization is required according to the payer’s criteria.
• Gather, collect and document information necessary for the review of prior authorizations request.
• Review prior authorization requests utilizing approved criteria/guidelines to ensure medical necessity of requested services/procedures. Make and receive calls on the status of authorizations requests.
• Communicate review outcomes to providers.
• Refer cases not meeting criteria/guidelines for physician review as necessary.
• Maintain an understanding of insurance plan requirements.
• Obtain requests and process information for external insurance referrals.
• Communicates authorizations/referral numbers to appropriate clinic and/or hospital staff.
• Other duties as assigned.
  
  -

Hours/Shifts

80 hours biweekly, day shifts

Compensation

Wage Range: $19.48-28.48/hour. Please note that final compensation will be determined based on experience, qualifications and internal equity considerations.

Benefit Offerings

Lake Region Healthcare is pleased to offer a comprehensive benefit program designed to meet your unique needs. This includes medical and dental coverage; HSA, FSA and 401k plans; EAP, life and disability coverage; voluntary accident, critical illness and hospital indemnity coverage; pet insurance, ID theft protection and legal services. For new employees, the effective date of coverage for most plans is the first of the month, following a 30-day waiting period.

EEOC

Lake Region Healthcare provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Requirements are representative of minimum levels of knowledge, skills, and/or abilities.

1. Education/Special Skills: Health and insurance knowledge is preferred but not required. Must have the ability to communicate proficiently and professionally in both verbal and written methods. Experience/knowledge of authorizations, referrals, verifications, CPT and ICD 10 coding, and medical claims process is desired.
2. Successful completion of the pre-employment health screening process required
3. Must be able to attend the work site per schedule