Date Posted September 17, 2026 Type Full Time Department Human Resources Location Van Diest Medical Center 2350 Hospital Drive Webster City, IA 50595, US Job Details The Prior Authorization and Referral Specialist performs the following, according to established guidelines: obtains precertification authorization from insurance companies for patients with scheduled surgical procedures, and various tests, including MRIs, CTs, and Sleep studies. In doing so, identifies and contacts patient's insurance company for eligibility, pre-existing, and exclusions; provides patient's medical history, treatments received, current conditions, and planned surgical treatment. Determines if prior approval is needed and notifies the appropriate department staff of outcome and the patient, when necessary. Obtains precertification, prior approval, or pre-determination authorization for scheduled tests and surgical procedures by contacting patient's insurance company, including workman's compensation carriers, for eligibility, pre-existing, or exclusions; provides patient's medical history, treatments received, current conditions, and planned testing or surgical treatment. Determines if prior approval is needed and notifies the appropriate department staff of outcome and the patient when necessary. In doing so either contacts insurance company by phone, fax or completes documentation via on line computer form with pertinent information including patient history, diagnosis, current symptoms. Assists in answering patient questions when they present regarding insurance coverage for a procedure and if authorization is required, or will direct accordingly. Notifies appropriate Business Office staff of any possible problems in payment for a procedure, i.e. no insurance or non-covered procedures or services. Documents in the computer system the precertification, prior approval or pre-determination authorization information from the insurance company. Interacts with physicians, nurses, coders, and other Clinic staff to gather patient information needed for precertification, prior approval, or pre-determination process. Schedules referral appointments with specialists, as ordered Schedules routine and follow up appointments for patients as needed Updates patient demographics if inaccuracies are found. Abides by the Standards of Conduct. Follows all infection control, safety and general hospital policies and submits all follow up paperwork to human resources, employee health and all other departments as requested in the time allowed. Completes all required competencies. Maintains a written log of all important information and activity to keep an accurate record to verify actions taken Communicates messages and important information to fellow employees and supervisor through the email, phone, or in-person at shift change. Email will remain open throughout shift, and employee will read and respond to emails in a prompt manner Participates in all quality assurance activities, documentation, data collection and other training as requested. Utilizes computer hardware and software or other computer based equipment in performing most essential functions of the job. Works to maximize office efficiency. Maintains organized and neat work area. Maintains current level of knowledge and skill related to education, tools equipment. Participates on various Hospital committees, when assigned and completes assignments within given time. Other duties as assigned. .9 FTE Monday-Friday between the hours of 7:00am and 5:00pm.

Requirements Education:

High school diploma or GED required. Must be able to speak, hear and understand the English language.

Experience:

Minimum of 2 years computerized data entry experience required. Reception or clerical experience at a healthcare setting is preferred. Proficiency in use of Microsoft Office applications, specifically Word and Excel, e-mail, and internet/web searches is preferred. Knowledge of computer to research, input, update information pertinent to specific tasks. Interpersonal skills necessary in order to deal effectively with physicians, clinic personnel, insurance company representatives and patients in exchanging patient information to obtain precertification authorization.

Additional Skills and Abilities:

Knowledge of basic anatomy, physiology, coding and medical terminology in order to interpret patient history and treatments at a level normally acquired through completion of a one year medical assistant or medical secretary program. Ability to concentrate and pay close attention to detail when reviewing patient medical record, insurance information, and entering data into the computer system which occupies approximately 75-80% percent of work time. Contact Information Questions? Please contact Human Resources at (515) 832-7711. Apply online at www.vandiestmc.org under "Careers" link at bottom of page.