Triage Prior Authorization Appeal Coordinator

Iowa Orthopedic Center is actively seeking a Triage Pre-Auth Appeal Coordinator to support orthopedic providers in delivering high-quality patient care. The Triage Pre-Auth Appeal Coordinator specializes in managing prior authorization appeals and peer-to-peer reviews on behalf of Iowa Ortho providers. This role ensures patients receive necessary approvals for testing, surgeries, medications, and other treatments by crafting compelling appeals, coordinating provider reviews with insurers, and identifying trends to improve authorization outcomes. The ideal candidate thrives in a fast-paced environment, has strong problem-solving skills, and is committed to advocating for both providers and patients.

Key Responsibilities:

Appeals & Peer-to-Peer Coordination

• Manage the appeal and reconsideration process for denied authorizations, including compiling medical documentation, physician notes, and relevant policy language.
• Act as the primary liaison between Iowa Ortho providers and insurance carriers, advocating for treatment approvals.
• Coordinate and facilitate peer-to-peer reviews between providers and insurers to challenge denials.
• Work closely with the triage nurse and providers to schedule provider-only peer-to-peer reviews.
• Contact insurance companies to discuss claim denials, negotiate coverage, and escalate unresolved issues.

Documentation & Compliance

• Maintain accurate and timely documentation in electronic medical records (EMR) and internal worklist programs.
• Organize and manage digital and paper files related to appeals, reconsiderations, and peer-to-peer reviews.
• Obtain necessary medical records and supporting evidence from external sources such as hospitals, physical therapy providers, and specialists.
• Ensure compliance with all policies, procedures, and regulatory requirements while upholding Iowa Ortho’s professional standards.

Process Improvement & Trend Analysis

• Monitor denial trends and identify opportunities to improve the prior authorization and appeal process.
• Escalate payer-related issues, process inefficiencies, or emerging trends to management.
• Collaborate with leadership to refine workflows and enhance efficiency in the authorization process.

Team Dynamics

• Collaborate with peers to ensure a strong, cohesive team environment within the Triage department.
• Maintain a professional and patient-centered approach in all communications.
• Ensure strong attendance and reliability due to the time-sensitive nature of appeals and authorizations.
• Perform additional duties as assigned to support department needs.

• Associate’s degree with at least one year of administrative or coordination experience in the medical field.
• OR High school diploma with three years of directly related experience in a medical office or insurance setting.
• Strong knowledge of medical terminology, insurance policies, and payer guidelines.
• Proficiency in EMR systems and ability to learn internal worklist programs.
• Excellent communication, negotiation, and problem-solving skills.
• Detail-oriented with strong organizational and analytical abilities.
• Ability to multitask and work effectively under deadlines.

Why Choose Iowa Ortho?

• Competitive Benefit Package: Competitive pay, health, dental, paid time off, paid holidays, 401(k) with company match, profit-sharing, employee discounts and more.
• Center of Excellence: Physician-owned orthopedic clinic and surgery center dedicated to providing exceptional medical care to the people of central Iowa. Discover why Iowa Ortho is a recognized center of excellence in orthopedic care.
• Cutting-Edge Environment: Work in a state-of-the-art facility that embraces the latest advancements in medical technology.
• Team Atmosphere: Join a collaborative team that supports one another and is committed to enhancing patient care.
• Professional Growth: Opportunities for career advancement and continuous learning.

Join our team and be a part of our commitment to delivering gold-standard healthcare!

*Please note our first point of contact may be by email. Please check your spam folder, as unknown senders sometimes wind up in spam or junk.

Iowa Ortho is a privately held medical practice. Candidates who receive a conditional offer of employment at Iowa Ortho will be required to complete a criminal background check, education verification, reference checks, and an initial TB test.

Iowa Ortho is committed to a diverse and inclusive workplace. Iowa Ortho is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.