Prior Authorizations

Prior Authorizations – Primary Care

Workplace Details

Join our team and see why Prairie Lakes Healthcare System continues to be named a Top Rural and Community Hospital year after year. Be a part of our mission to make a positive difference in the health of the patients and communities we serve by delivering accessible, high-quality, affordable, and compassionate healthcare. Prairie Lakes Healthcare System is an independent, non-profit rural healthcare system serving 10 counties in northeastern South Dakota and west-central Minnesota.

Job Summary

This position reviews and validates insurance eligibility, prior authorization and/or referral of medication, testing, procedures, and surgery is completed and confirmed.  Contacts third party payer to determine appropriate prior authorization process. Reviews professional services denials; works with clinics and third-party payers on appeal process. Collaborates with care teams, case management, and other cross-functional teams.  Assists patients with insurance related questions and problems, corrects insurance computer screens, assists patients in filing insurance claims and completing insurance forms, works with insurance companies to pre-certify patients for surgery, answers patient correspondence, and performs related duties.

Responsibilities include:

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 arrangement.
Responsible for assuring that prior authorization for medical services, including testing, procedures, surgery, and medications is completed and confirmed.  Contacts third party payer to determine appropriate prior authorization process.
Reviews 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 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 appropriate physician wing, answering switchboard calls, and directing calls to appropriate location.  Performs related duties to include answer patient correspondence, and sorting mail for the department.
Other duties as assigned

Benefits

Prairie 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 Account

·        Roth IRA retirement plan

·        Employee Assistance Program for mental health

·        Education Loan Program

·        Community discounts including the Prairie Lakes Wellness Center

Qualifications

Medical Assistant (MA) or two years of experience in scheduling preferred.

Prairie Lakes Healthcare System has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.