Preadmissions Representative

Location:

Sioux Center, IA

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Discover a Career of Faith and Healing: For over 70 years, Sioux Center Health has served patients with Jesus’ healing ministry. With eight locations located in Sioux Center, Iowa and surrounding communities, we take great pride in providing superior care in our state-of-the-art facilities.

A Career that You Will Love: There’s no other way to say it: You will love working here. Between our strong mission and our great people, we have nurtured a pretty exceptional culture at Sioux Center Health.

A Chance to Make a Difference: Working with us means making a real difference in the lives of our community members. Your talents and your passions are truly appreciated here. In addition to the service we provide, Sioux Center Health also supports our community with sponsored programs and events, and other volunteer work. If this is your passion, you need to consider joining our team driven to provide quality care and services within a caring Christian culture.

Position Highlights

Sioux Center Health has been awarded a Top 100 Critical Access Hospital award, Top Workplace honor by The Des Moines Register, and won Best of the Northwest in 13 healthcare categories including Best Place to Work. Sioux County also ranked #6 in the nation for being one of the Healthiest Communities according to U.S. News & World Report and CVS.  There’s a reason we are a recognized healthcare leader.

Summary

• The Preadmissions Representative is responsible for determining eligibility for all applicable payors by facilitating and overseeing Local Coverage Determinations (LCDs) as well as obtaining timely prior authorization from insurers for medical tests, procedures, surgeries and specialty appointments ordered by the provider.

General Hours of Work

• Monday through Friday, call-in extra as needed

Education and/or Experience

• Knowledge in ICD-10 and CPT coding preferred. Minimum of 2 years of healthcare experience and/or coding certification is recommended. General computer knowledge required. Bi-lingual experience preferred but not required.

Certificate, Licenses, Registrations

• N/A

Essential Functions

• Determines eligibility for all applicable payors by obtaining prior authorizations from insurers for medical tests, procedures, surgeries and any other prior authorizations required by the patient’s insurance carrier or Local Coverage Determination (LCD) if needed.
• Appropriately documents prior authorization and communicates information to performing facility, physician, clinic staff and patient and/or patient’s family as necessary.
• Obtains information (including written or verbal physician orders) from physician offices for scheduling tests, procedures and admissions in an accurate, timely and sequential manner.
• Demonstrates good rapport, continual education updates and cooperative working relationships with physician office staff, all hospital departments, physicians and co-workers. 
• Provides timely information to the supervisor regarding the prior authorization process, staffing, customer service (physician office staff, all hospital departments, physicians and co-workers).
• Serves as a resource to assist non-licensed staff in problem solving, medical necessity, non-covered service and medical terminology.
• Assists with collection, sharing and maintenance of records and orders per Sioux Center Health guidelines.
• Demonstrates technological knowledge and skills sufficient to integrate the use of health care technology and/or information management systems as it pertains to prior authorizations.
• General clerical duties to include, but not limited to making copies, faxing documents,  answering/ monitoring phones, and relaying messages.
• Performs other duties and responsibilities as assigned.