Rn-prior authorization/referral procedure and insurance coordinator Job at IntelyCare (Des Moines)

Job Description

RN, Prior Authorization/Referral/Procedure and Insurance Coordinator functions as a clinician, educator and resource for patients within their specialty of care and up to their licensure in scope of practice. Facilitates all facets of the patient referral process and pre-authorization of insurance payments prior to appointments.

Job Responsibility

Coordinates and develops ongoing patient care, including appointments, communication, and instruction
Function as a clinician, educator and resource for patients within their specialty of care
Assist provider and clinical staff with patient prep for examinations, treatments, and minor clinic procedures
Delivers high quality care utilizing the nursing process while demonstrating knowledge and clinical skills in accordance with established policies, procedures, and standards of care throughout the clinic and across the health care continuum
Maintain flexibility by demonstrating an ability and willingness to perform a variety of duties and accept changes or additions to assignments
Thoroughly understand testing (lab and procedures) values and relationship to patient status with accountability to take next steps, as appropriate to scope and licensure
Utilize critical thinking in making independent judgements and maintains responsibility and accountability for the knowledge of conditions of assigned patients
Builds and maintains positive working relationships with patients, physicians, and all others
Perform other duties as requested by Manager of Oncology Services to facilitate the smooth and effective operations of the hosp/clinics
Maintains knowledge of clinical protocols to facilitate timely and complete work up of patients
Obtain necessary pre-authorization requirements for office, clinic/hospital studies/procedures, diagnostic testing, and imaging for patients as ordered by physicians
Work closely with clinical department and physicians to provide additional information when nurse review or peer-to-peer requests are made by the insurance carrier
Maintains current knowledge of patients’ insurance carriers as well as payer specific requirements of prior authorizations by attending virtual workshops, researching, reading newsletters
Monitors outstanding authorization requests and initiates follow-up of outstanding authorizations in a timely manner
Coordinates appointments, forms and requisitions and relays timely authorization information to scheduling staff

Requirements

Graduate of an accredited school of nursing or IA Board of Nursing approved nursing program
Current licensure in good standing to practice as a Registered Nurse in Iowa
Valid driver's license
Basic Life Support (BLS) ceritification or obtain certification within three months from date of hire
Mandatory Report Certification
Two (2) years of RN experience

Nice to have

BSN degree preferred
Experience in the oncology setting preferred
Experience with insurance verification/ pre-authorizations preferred

What we offer

paid time off
parental leave
401K matching
employee recognition program
Dental and health insurance
paid holidays
short and long-term disability
pet insurance
Early access to earned wages with Daily Pay
tuition reimbursement
adoption assistance

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Rn-prior authorization/referral procedure and insurance coordinator

Job Description

Job Responsibility

Requirements

Nice to have

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