Clinical Insurance Authorization Specialist Spencer Hospital

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Position Highlights

Spencer Hospital is a rural hospitallocated in northwest Iowa employing over 500 employees. Positions at Spencer Hospital are not affiliated with Avera; however we collaborate to provide services to the communities we serve. Employment offers if accepted are exclusively with Spencer Hospital.

Responsibilities:

• Coordinate with staff in order to complete prior authorization for all services and procedures in an accurate and timely manner.
• Ensure that all supporting documentation is available and shared with payers to expedite authorizations.
• Maintaining authorizations which includes gathering necessary documents to support authorization requests submitting initial requests for authorization following up on authorization requests and communicating with departments and providers on status of authorizations.
• Coordinate with providers as needed to ensure treatments/services meet medical necessity criteria. Assist with appeals for claim denials due to the authorization process.
• Develop and implement prior authorization workflow policies and procedures. Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner.
• Share information with providers and staff regarding coverage criteria medically necessary criteria.

Requirements:

• Current active Licensed Practical Nurse (LPN) license in Iowa or an active multistate license through the Nurse Licensure Compact (NLC). Must be eligible to practice in Iowa.
• Prior hospital and/or clinical authorization experience preferred.
• Must uphold high ethical standards.
• Exhibit poise and tact when working with staff physicians and other members of the healthcare team.
• Excellent oral communication skills and the ability to interact with customers in a professional manner are essential.
• Must be adaptable and flexible in moving between various functions based on workload demand.
• Must have excellent organizational skills.

Schedule:

• 72 or 80 hours per pay period
• Mon-Fri; 8a-4:30pm
• The schedule may fluctuate based upon the needs of the hospital

Spencer Hospital offers competitive wages affordable insurance IPERS retirement in-house education paid time off family gym membership and so much more!

Please contact Spencer Hospital Human Resources for any questions at 712.264.6205 or email .

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