Job Description
Job Title: Prior Authorization Nurse (LPN)
Requisition Status: Pending
Status Reason: Pending Sourcing
Reason: Peak in Census
Department: RC Billing (8282-099)
Job Category: Remote - Non-clinical - Administrative
Job Code: Prior Authorization Nurse (LPN)
Number of Positions: 1
Remaining Positions: 1
Location: Saint Paul, Minnesota, United States
Pay Rate: */hour
The Prior Authorization Nurse (LPN) is responsible for ensuring quality and cost-effective medical care by evaluating prior authorization requests using clinical expertise and established policies. This role requires strong collaboration with patients, healthcare providers, and insurance companies to facilitate smooth and timely approvals.
Job ResponsibilitiesProcess authorizations, certifications, and referrals to maximize reimbursement for both patients and the organization.
Verify patient insurance benefits and eligibility to determine prior authorization requirements and provide patients with an estimated financial responsibility.
Ensure compliance with all Joint Commission requirements , including cultural sensitivity, patient rights, safety, emergency management, and ethical treatment.
Maintain professional and ethical behavior as per licensing guidelines and company policies.
Work collaboratively in an interdisciplinary team to coordinate patient care efficiently.
Communicate effectively across departments to ensure high-functioning integrated teamwork.
Minimum of one (1) year of nursing experience in a healthcare environment.
Knowledge of payer requirements and prior authorization processes .
Familiarity with CPT/HCPCS codes and ICD-10 coding.
Experience in pharmacy, pharmaceuticals, or healthcare business is beneficial.
Strong analytical and clinical interpretation skills.
Ability to work effectively across teams and foster a collaborative work environment.
Excellent customer service and communication skills (verbal, written, and listening).
Proficiency in Microsoft Office Suite , databases, and other healthcare-related software.
Strong problem-solving and decision-making abilities.
N/A
Required: Completion of a practical nursing program (LPN program) .
If holding an RN license , documentation of RN education program completion is required.
Required:
Licensed Practical Nurse (LPN) license from the MN Board of Nursing.
Candidates with a valid Registered Nurse (RN) license in Minnesota are also eligible.
Preferred: Active professional affiliations and/or national certification related to the clinical specialty.
English: Read, Write, Speak
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