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.