Preadmissions Representative

Location: Sioux Center, IA | Worker Type: Regular | Work Shift: Day Shift (United States of America) Position Highlights Top workplace recognized by The Des Moines Register. Member of a community ranked #6 in healthiest communities by U.S. News & World Report. Summary: The Preadmissions Representative is responsible for determining eligibility for all applicable payors by facilitating and overseeing Local Coverage Determinations (LCDs) as well as obtaining timely prior authorization from insurers for medical tests, procedures, surgeries and specialty appointments ordered by the provider. General Hours of Work: Monday through Friday, call-in extra as needed. Education and/or Experience Knowledge in ICD-10 and CPT coding preferred. Minimum of 2 years of healthcare experience and/or coding certification recommended. General computer knowledge required. Bi-lingual experience preferred but not required. Essential Functions Determine eligibility for all applicable payors by obtaining prior authorizations from insurers for medical tests, procedures, surgeries and any other prior authorizations required by the patient’s insurance carrier or Local Coverage Determination (LCD) if needed. Appropriately document prior authorization and communicate information to performing facility, physician, clinic staff, patient and/or patient’s family as necessary. Obtain information (including written or verbal physician orders) from physician offices for scheduling tests, procedures and admissions in an accurate, timely and sequential manner. Demonstrate good rapport, continual education updates and cooperative working relationships with physician office staff, all hospital departments, physicians and co-workers. Provide timely information to the supervisor regarding the prior authorization process, staffing, and customer service. Serve as a resource to assist non-licensed staff in problem solving, medical necessity, non-covered service and medical terminology. Assist with collection, sharing and maintenance of records and orders per Sioux Center Health guidelines. Demonstrate technological knowledge and skills sufficient to integrate the use of health care technology and/or information management systems as it pertains to prior authorizations. Perform general clerical duties to include making copies, faxing documents, answering/monitoring phones, and relaying messages. Perform other duties and responsibilities as assigned. Additional Information The role is part of a compassionate care environment that values faith and quality services. #J-18808-Ljbffr Sioux Center Health