Prior Authorization LPN/RN

Job Title: Prior Authorization LPN/RN Location: Johnson County Hospital, Tecumseh, NE Department: Nursing Reports To: DON Position Summary: The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. Duties & Responsibilities: Review chart documentation to ensure patients meet medical policy guidelines Prioritize incoming authorization requests according to urgency Obtain authorization via payer website or by phone and follow up regularly on pending cases Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations Initiate appeals for denied authorizations Respond to clinic questions regarding payer medical policy guidelines Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order Contact patients to discuss authorization status Works with patients regarding insurance eligibility and pricing estimates for front end collections for medical services Other duties as assigned Qualifications & Skills: Knowledge of procedure authorization and its direct impact on the practice's revenue cycle Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively Basic understanding of human anatomy, specifically musculoskeletal Proficient use of CPT and ICD-10 codes Excellent computer skills including Excel, Word, and Internet use Detail oriented with above average organizational skills Plans and prioritizes to meet deadlines Excellent customer service skills; communicates clearly and effectively Ability to multitask and remain focused while managing a high-volume, time-sensitive workload LPN or RN license in the State of Nebraska 2 years medical prior authorization experience preferred 2 years experience in a medical related field required Benefits We Offer: Competitive wages Comprehensive health, dental, and vision insurance Retirement savings plan Professional development opportunities Supportive and collaborative work environment Paid time off Sick pay Why Join Us? At Johnson County Hospital, we value our team and foster a supportive environment where you can thrive. Join us to make a difference in the lives of our patients and their families. #J-18808-Ljbffr Johnson County Hospital