RN - Pre-Authorization/Insurance Coordinator - Cardiology Clinic

Job Overview

Overview

We are looking for a full-time RN to join our Cardiology team! Work hours will be days, Monday - Friday, 7:30 am - 4:00 pm or 8:00 am - 4:30 pm, for 80 hours per pay period.

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.

Why UnityPoint Health? 

• Commitment to our Team – We’ve been named a  Top 150 Place to Work in Healthcare 2022  by Becker’s Healthcare for our commitment to our team members. 
• Culture – At UnityPoint Health, you Come for a fulfilling career and experience  a culture  guided by uncompromising values and unwavering belief in doing what's right for the people we serve. 
• Benefits – Our competitive  Total Rewards  program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. 
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation. 
• Development – We believe equipping you with support and  development opportunities  is an essential part of delivering a remarkable employment experience. 
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve. 

Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work.  https://dayinthelife.unitypoint.org/  

Responsibilities

Patient Care, Education and Clinical Support

• 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 and assist physicians with office procedures.
• Assist provider and clinical staff with patient prep for examinations, treatments, and minor surgical 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 Director of Clinical Operations to facilitate the smooth and effective operations of the office.

Care Coordination/Precertification and Prior Authorization Certification

• 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 of specialist or outpatient service offices as requested.

Basic UPH Performance Criteria

• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
• Demonstrates ability to meet business needs of department with regular, reliable attendance.
• Employee maintains current licenses and/or certifications required for the position.
• Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
• Completes all annual education and competency requirements within the calendar year.
• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Qualifications