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Schedule Weekly Hours:

Gundersen Health System is looking to add a Prior Authorization Specialist to our team!

In this role, You will:

• Navigate complex insurance regulations and advocate for patients' needs

• Process paperwork effectively and efficiently to ensure all documentation is completed

• Maintain strong communication both verbally and written

What's Available:

• Full time, 1.0 FTE - 40 hours/ week

• Monday-Friday hours between 7:30am-4:30pm

• This is an onsite position in La Crosse, WI

• Starting pay of $19.52/hour + more for experience!

What You'll Need: 

• High School Diploma or equivalency

• 3-4 years experience in healthcare with insurance or prior authorization experience.

• Excellent problem-solving abilities and strong attention to detail

• Strong communication skills, both verbal and written

What You'll Get:

• Support to grow in your career with access to our Career Development Center and Tuition Investment Program

• Top-rated retirement plan and healthcare benefits

• Departmental leadership that supports you as you do your best work.

• Work/Life balance to love what you do and where you live.

About Gundersen Health System:

Gundersen Health System is a physician-led, not-for-profit healthcare system that includes a teaching hospital; community clinics; affiliate hospitals, clinics, and nursing homes; behavioral health services; vision centers; pharmacies; and air and ground ambulance services. We serve more than 500,000 residents throughout 19 counties throughout western Wisconsin, northeastern Iowa, and southeastern Minnesota. Our La Crosse, WI main campus is a 325-bed teaching hospital, tertiary referral center, and a Level II Trauma Center. Our mission is to deliver Love + Medicine every day to change lives in our communities and enrich the lives of our employees.

Job Description:

The Prior Authorization Specialist works with departments and insurance companies to obtain the necessary pre-certifications and authorizations for services ordered/scheduled by Gundersen Health System. Once received these are recorded in EPIC to ensure appropriate billing. The Prior Authorization Specialist maintains a high level of understanding of insurance companies and billing authorization requirements.

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Major Responsibilities:

1. Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for identified patients.

2. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process.

3. Collaborates with Supervisor, internal departments and clinical staff as needed to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.

4. Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems.

5. Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.

6. Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.

7. Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization/certification is denied.

8. May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.

9. Maintains files for referral and insurance information, and enters referrals into the system.

10. Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.

11. Serves as an expert for peers across