Prior Authorization Specialist - LPN at Northfield Hospital & Clinics – Northfield, Minnesota

• Works 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.

• High School diploma or equivalent
• Current LPN license with the Minnesota Board of Nursing, in good standing
• Must be able to speak, read, and write English proficiently to ensure safe and effective communication in a healthcare environment
• Previous customer service experience
• General computer skills and experience
• Ability to work in a high volume/fast-paced environment

• Prior authorization knowledge/experience

• Monday-Friday 8:30am-5:00pm
• Onsite at Northfield Hospital with potential for some hybrid work after initial training period.

• Paid Time Off accrued starting on first paycheck
• Medical, Dental, and Vision (discount plan) coverage
• Flexible Spending Accounts
• Life, AD&D, and Disability Insurance
• Pension Plan (PERA) with 7.5% employer match
• Optional 457(b) Retirement Plans
• Tuition Reimbursement
• Loan Forgiveness Eligibility – PSLF + MN state programs for qualifying roles
• Employer-Provided Certifications + Continuing Education
• Additional perks: Free On-Site Parking, Qualified Bilingual Staff Program, Employee Assistance Program, and discounts on cafeteria, scrubs, and OTC pharmacy items

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.

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