Prior Authorization Specialist (MA or LPN)

Prior Authorization Specialist (MA/LPN)

The Prior Authorization Specialist (MA/LPN) is responsible for managing the end-to-end prior authorization (PA) process for medications. This role ensures timely submission, tracking, and resolution of PA requests while maintaining accurate documentation and communication with providers, nursing staff, pharmacies, and patients. The Specialist assumes primary responsibility for PA workflow management, escalating clinical decisions or licensing-dependent tasks to the appropriate RN or provider when required.

We are committed to providing wage ranges for all open positions. Compensation for this role will be determined based on experience, education, and internal equity considerations. The hourly wage range for this position is: Medical Assistant: $21.08$29.76 per hour; Licensed Practical Nurse (LPN): $22.80$32.18 per hour. These ranges reflect the base pay for each position.

Key Accountabilities

• Manage and track medication prior authorization requests from start to finish to ensure timely completion
• Monitor and maintain work queues to ensure timely follow-up and completion of all requests.
• Coordinate communication between providers, pharmacies, payers, and patients to facilitate the authorization process.
• Gather and submit required documentation and respond to payer inquiries or additional information requests.
• Process and document authorization outcomes, including approvals, denials, and appeals.
• Collaborate with providers on next steps related to denials and alternative treatment options.
• Maintain accurate, compliant documentation across all systems and workflows.
• Identify and escalate issues requiring clinical judgment or licensure as appropriate.
• May provide backup support for direct patient care activities as needed to support clinic operations. Responsibilities may include preparing exam and treatment rooms, assisting with patient intake and rooming, obtaining and documenting vital signs, administering medications per policy, assisting providers during exams and procedures, performing ordered clinical tasks, collecting lab specimens, and ensuring completion of provider orders. May also support communication of patient information and test results, escalate urgent patient needs to appropriate staff, and assist in maintaining equipment readiness, supply levels, and proper cleaning and sterilization of instruments.

Required Qualifications

• Must be over 18 years of age
• High School Diploma or equivalent
• LPN or MA (Non-Certified/Non-Registered applicants must have graduated from an accredited school with a clinical externship and provide proof of school completion.)
• Current American Heart Association BLS for Healthcare Providers Certification (or obtain within six months of hire)

Preferred Qualifications

• CMA or RMA preferred
• One year of clinical practice experience
• Ability to communicate effectively in both written and verbal English
• Electronic medical record experience

Schedule

• 64 hours per two-week pay period (0.8 FTE)
• Monday-Friday, 8:00am-4:30pm

Benefits

• Eligible for Shift Differential Pay in addition to base wage
• Paid Time Off accrued starting on first paycheck
• Medical, Dental, and Vision (discount plan) coverage
• Flexible Spending Accounts
• Life, AD&D, and Disability Insurance
• Pension Plan (PERA) with 7.5% employer match
• Optional 457(b) Retirement Plans
• Tuition Reimbursement
• Loan Forgiveness Eligibility PSLF + MN state programs for qualifying roles
• Employer-Provided Certifications + Continuing Education
• Additional perks: Free On-Site Parking, Qualified Bilingual Staff Program, Employee Assistance Program, and discounts on cafeteria, scrubs, and OTC pharmacy items

Northfield Hospital + Clinics is a trusted, independent healthcare system with more than 800 employees. We're recognized for our collaborative work environment and strong commitment to high-quality patient care and community impact. We're proud to be named to Becker's 2025 list of "100 Great Community Hospitals." Our services span the full spectrum of hospital and clinical care, with our main hospital located in Northfield, MN, and primary and specialty clinics in Northfield, Lakeville, Farmington, Faribault, and Kenyonalong with Urgent Care locations in Northfield, Lakeville, and Farmington. We offer care across 48 specialties and serve patients at 22 locations throughout the south metro and southern Minnesota. Whether you're just starting your career or bringing years of experience, you'll find meaningful opportunities, supportive teams, and a chance to make a real difference here. *This posting is not a complete list of duties or responsibilities. Job functions, schedules, and terms of employment may change in accordance with applicable laws, policies, and agreements.