Prior Authorization Representative

Job SummaryJoin our team and be a part of our mission to deliver accessible, high-quality, affordable, and compassionate healthcare. Prairie Lakes Healthcare System is a non-profit healthcare system serving 10 counties in northeastern South Dakota and west-central Minnesota. Our team at Prairie Lakes makes a difference in the lives of patients and their loved onesPOSITION SUMMARY:Wage: 18.66-27.59This full-time position (1.0 FTE or 40 hours per week) is responsible for reviewing and validating insurance eligibility and ensuring that prior authorizations and/or referrals for medications, tests, procedures, and surgeries are completed and confirmed. The role includes contacting third-party payers to determine appropriate authorization processes, reviewing professional service denials, and collaborating with clinics and payers on appeals. The position works closely with care teams, case management, and other cross-functional teams while assisting patients with insurance-related questions and issues.RESPONSIBILITIES:Assists patients with insurance-related questions and problems, such as balances and questions on charges, corrects insurance computer screens, and assists patients in filing insurance claims and completing insurance forms.Processes Medicare and Welfare account transfers, denials, missing numbers, supplement claims, and bulletins.Counsels patients regarding financial responsibilities, aids in making a workable payment arrangementResponsible for assuring that prior authorization for medical services, including testing, procedures, surgery, and medications, is completed and confirmed. Contacts third third-party payer to determine the appropriate prior authorization processReviews and validates insurance eligibility, prior authorization, and/or referral of medication, procedures, etc. Reviews professional services denials; works with clinics and third-party payers on the appeal process.Sends statements to counties for payment, and sends itemized statements to patients upon request.Registers patients, sets up new patient accounts, checks insurance card against patient coverage on computer screen, updates information, verifies patient address and phone number, and ensures completion of all areas on patient information screens, photocopies insurance cards, determines method of payment for appointments, collects co-payments, payment arrangement payments, and writes receipts. Verifies necessity for referral and assists in obtaining referral or pre-certification information.Performs related duties to include directing patients to the appropriate physician wing, answering switchboard calls, and directing calls to the appropriate location. Performs related duties to include answering patient correspondence and sorting mail for the department.Other duties as assignedJOB SPECIFICATIONS:Education And/or ExperienceHigh school diploma or general education degree (GED); or equivalent combination of education and experience.Medical Assistant (MA) or two years of experience in scheduling preferred.BenefitsPrairie Lakes Healthcare System offers comprehensive benefits for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 403(b)-retirement plan, and generous paid time off to maintain a healthy home-work balance.Additional benefits for those qualifying include:Flexible Spending AccountEmployee Assistance Program for mental healthEducation Loan ProgramCommunity discounts including the Prairie Lakes Wellness CenterPrairie Lakes Healthcare System has a Drug Free Workplace Policy. An accepted offer will require positive reference checks and pre-employment background screening as a condition of employment.