Prior Authorization/Orders Coordinator

At Mahaska Health the primary role of the Prior Authorization/Orders Coordinator will be responsible for verifying if a prior authorization is needed or has been obtained, the proper authorization numbers are in the EHR system, and all outpatient orders have been checked for medical necessity and prior authorized if necessary.

Essential job responsibilities include but are not limited to,

• All orders will be checked for completeness and accuracy. Missing information will be obtained by this position.
• A BOR Request will be sent for any/all providers not already in the Mahaska Health system. This will verify them for a valid license, and any suspensions, and to confirm their National Provider Identifier (NPI), address, phone number, and fax number.
• All Medicare orders will be run through compliance validating software to check for medical necessity. If a test does not meet medical necessity, the provider will be contacted for additional documentation.
• Responsible for obtaining and ensuring prior authorization is completed and approved prior to the test being scheduled.
• Will reach out to the patient to discuss the need to obtain an Advanced Beneficiary Notification (ABN) at check-in, if one is required and not already obtained.
• Daily schedules will be run to ensure that all orders are received, and prior authorizations are obtained prior to the patient presenting for the service.
• Work assigned EPIC Work queues.
• Maintains current knowledge of Patient Accounts policies and procedures in order to assist patients and staff.
• Review and process prior authorization requests for medical services and procedures.
• Communicate with healthcare providers to verify and clarify information needed for authorization.
• Collaborate with insurance companies to obtain necessary authorizations and resolve any issues that arise.
• Maintain accurate records of authorization requests, including status updates and outcomes.
• Educate patients about their coverage options and the prior authorization process.

Job Requirements include but are not limited to,

• A graduate from an accredited school of nursing and currently licensed as a Registered Nurse in the state of Iowa (or) a graduate from an accredited school of nursing and currently licensed as a Registered Nurse able to work in the state of Iowa.
• Current AAPC or RHIT certification required.
• Proven experience in a healthcare setting, specifically in prior authorization or medical billing preferred.
• Knowledge of ICD-10-CM, HCPCS, and CPT-4 coding, medical terminology, anatomy and physiology is required.
• Strong knowledge of medical terminology, coding, and billing practices.
• Familiarity with various insurance policies and procedures related to prior authorization.
• Excellent communication skills, both written and verbal, to interact effectively with providers, patients, and insurance representatives.
• Ability to analyze information and make sound decisions based on policy and regulation.