Insurance Authorization Specialist Jobs in Iowa

Works with the Order Management team to secure any additional information and medical documentation from the patient and/or prescribing HCP.

Medical terminology and ICD-10 coding: Knowledge of and interpretation skills

One (1) year previous experience of insurance verification or medical authorization experience involving medical record review.

Personal career, skill, and leadership development opportunities

Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans.

Utilizes payer-specific approved criteria to determine medical necessity or the clinical appropriateness for the company’s products.

Knowledge, Skills, and Abilities - Required:

Proficient in utilization management processes, standards, and managed care.

Knowledge of patient rights and laws relative to those rights, such as HIPAA.

Proficient in standard medical practices and insurance benefit structures.

Remote position with training on-site

High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.

Knowledge of insurance requirements regarding face-to-face documentation.

Bachelor’s Degree or equivalent combination of education and experience

Assists in eligibility and benefits inquiries when necessary.

Determines the authorization requirements of each health plan and keeps detailed records of the medical policies and requirements.

Exhibits strong problem-solving skills through both verbal and written communications.

Experience with prior authorizations, pre-determinations, and out-of-network gap exceptions.

One (1) to two (2) years' experience of revenue cycle management or billing experience in the healthcare field

Alerts the RCM Supervisor or RCM Manager regarding late or missing documents required for billing.

Strong communication skills, oral and written.

Intermediate to advanced skills with Microsoft Office Suite, especially Excel.

You are flexible and can embrace change

You value progress over perfection

Knowledge of medical terminology is required, problem solving techniques, strong interpersonal skills, and effective oral and written communication skills.

Tuition Assistance Benefits are prorated for part-time positions

Benefits are prorated for part-time positions

Paid vacation, sick time & holiday time

Basic Life Insurance provided at no cost

Review Outpatient and Inpatient accounts for accurate insurance information using the electronic eligibility software and/or a telephone call to the payer.

Experience with Total Information Management System (TIMS) a benefit

Perform verification of eligibility and benefits to determine coverage and payer requirements

Actively seek additional experience and knowledge across all functional areas to gain expertise and perform other duties and projects as assigned

Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims

Assess clinical documentation to ensure all applicable prescription, face to face, and coverage criteria requirements are met

3+ years of industry experience, preferably in health insurance and/or durable medical equipment