Prior Authorization Specialist (LPN or RN)

Medical Associates is looking for an LPN or RN to join our team as a full-time Prior Authorization Specialist!

Schedule: 8:00am to 5:00pm Monday-Friday. Hours can be flexed, in coordination with other team members' schedules. Opportunity for work from home after training if desired!

Location: Medical Associates Health Plans, 1605 Associates Drive, Dubuque, IA 52002

What you'll be doing:

• Reviews and processes all assigned prior authorization requests to completion. Diligently reviews patient health care data, diagnostic testing and treatment information for completeness for insurance requirements and prior authorization process.
• Communicates with physicians, mid-level providers, and clinical staff as needed to obtain and understand clinical documentation requirements. Provide required clinical documentation to payers via phone, faxed forms, and/or website.
• Maintains documentation of authorization approvals and denials, including authorization numbers and associated codes, dates, and other relevant data.
• Collaborate with health care team in the event peer review or further documentation is requested.
• Communicate effectively with clinical staff, payer representatives, and providers.
• Demonstrate flexibility in performing other additional duties or assigned projects. Provide input for devising systems to improve processes, quality and efficiency of prior authorization workflow. Participate in required meetings.
• This role completes necessary clinical review for prior authorizations as required by governmental and commercial payers.

Knowledge, Skills & Abilities:
Experience: One to three years of similar or related experience.

Education: Equivalent to a two-year college degree or completion of a specialized course of study or certification at a business or trade school. Must be licensed LPN or RN.

Interpersonal Skills: A significant level of trust and diplomacy is required, in addition to normal courtesy and tact. Work involves extensive personal contact with others and/or is usually of a personal or sensitive nature. Work may involve motivating or influencing others. Ability to work independently and remain motivated in daily work is required. Outside contacts become important and fostering sound relationships with other entities (companies and/or individuals) becomes necessary.