Prior Authorization Specialist - LPN

Job RelationshipsDepartment: Prior AuthorizationSupervisor: Admissions ManagerSupervises: noneJob SummaryMonitors incoming orders and gathers necessary documentation to ensure pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services.CompensationWe are committed to providing wage ranges for all open positions. Please note that the specific compensation for this role will be determined based on experience, education and internal equity considerations. The hourly wage range for this position is $22.80-$32.18. This range reflects the base salary for this position.Key AccountabilitiesWorks with insurance companies and staff to obtain initial and ongoing authorizations for patients in advance of services.Reviews accuracy and completeness of information requested to ensure that all supporting documents are present.Provides feedback to referring provider office so patient services can be scheduled.Provides authorization number to internal teams (providers, billers, etc.).Researches, corrects, and resubmits rejected/denied insurance authorizations.Communicates with patients, clinic personnel, and providers over the phone, via email or other written documentation and responds to all inquires.Utilizes and maintains online prior authorization software.Serves as a liaison between the prior auth team, ordering providers, nursing staff and care coordination teams.Conducts clinically informed review of provider orders, documentation, and medical records to determine medical necessity based on payer guidelines and evidence-based criteria.Identifies missing, insufficient, or inconsistent clinical information and proactively obtains clarifications from providers.Reviews denial trends and recommends clinical-focused process improvements to reduce avoidable denials.Required QualificationsHigh School diploma or equivalentCurrent LPN license with the Minnesota Board of Nursing, in good standingMust be able to speak, read, and write English proficiently to ensure safe and effective communication in a healthcare environmentPrevious customer service experienceGeneral computer skills and experienceAbility to work in a high volume/fast-paced environmentPreferred QualificationsPrior authorization knowledge/experienceScheduleMonday-Friday 8:30am-5:00pmOnsite at Northfield Hospital with potential for some hybrid work after initial training period.BenefitsPaid Time Off accrued starting on first paycheckMedical, Dental, and Vision (discount plan) coverageFlexible Spending AccountsLife, AD&D, and Disability InsurancePension Plan (PERA) with 7.5% employer matchOptional 457(b) Retirement PlansTuition ReimbursementLoan Forgiveness Eligibility - PSLF + MN state programs for qualifying rolesEmployer-Provided Certifications + Continuing EducationAdditional perks: Free On-Site Parking, Qualified Bilingual Staff Program, Employee Assistance Program, and discounts on cafeteria, scrubs, and OTC pharmacy itemsAbout UsNorthfield 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 Kenyon-along 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 job posting is not intended to be an exhaustive list of all duties, responsibilities, or activities required of the position. Duties, responsibilities, and activities may change at any time with or without notice.Compensation, benefits, work schedules, and other terms and conditions of employment are subject to change in accordance with applicable laws, policies, and collective bargaining agreements, if applicable.