Full employer posting
$23.77 - $32.78 Hourly The Senior Pre-Authorization Specialist will facilitate the gathering of information to verify medical necessity to meet prior authorization and insurance referral requirements. Responsibilities include but are not limited to: Prior Authorization and Referral Coordination: Review and process prior authorization and external referral requests by gathering required clinical documentation, applying payer-specific guidelines and medical necessity criteria, communicating with insurance companies and providers regarding authorization status and outcomes, and escalating cases for physician review when necessary.
Authorization and Revenue Cycle Support: Coordinate and communicate authorization and referral information with providers, clinics, and hospital departments; ensure required orders and notifications are completed prior to scheduled procedures; collaborate with clinical teams to meet documentation requirements; and assist Revenue Cycle Leadership with projects related to denial management, tracking, and new service line development.
Hours/Shifts 80 hours biweekly, day shifts, Monday to Friday. Compensation Hourly Wage Range: $23.77-$32.78. 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.
Qualifications Requirements are representative of minimum levels of knowledge, skills, and/or abilities. Education/Special
LPN or 2 year healthcare degree 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.
Successful completion of the pre-employment health screening process required Must be able to attend the work site per schedule
About the role
Prior Authorization and Referral Coordination: Review and process prior authorization and external referral requests by gathering required clinical documentation, applying payer-specific guidelines and medical necessity criteria, communicating with insurance companies and providers regarding authorization status and outcomes, and escalating cases for physician review when necessary.