Riverview Health
Overview
RiverView Health, is a community owned, membership based non-profit organization that was formed in 1898 and continues to be the sole community hospital in Crookston, MN.
RiverView Health operates a 25 bed Critical Access Hospital, RiverView Recovery Center; a chemical dependency outpatient treatment program, RiverView Home Care and five primary care and specialty clinics in the hospitals service area.
We have a robust scholarship program for those furthering their education in a medical field, excellent benefits, and a friendly work environment. Full-time benefits include health insurance, free single vision and basic dental insurance, life insurance, long-term disability and short-term disability, and employer HSA contributions. Other benefits include employer pension matching, shift differential, incentive/premium pay, free annual biometric screening and paid volunteer time off.
RiverView is an Equal Employment Opportunity employer.
Responsibilities Prior Authorization Specialist - Temp
Schedule: Temp/Part-time (.5) - 40 hours per pay period
Scheduled Hours: Monday-Friday
Pay Range: $20.53 - $28.74 / hr (based on experience)
Job Status: Non-Exempt/Hourly, non-benefitted
This is a temporary part-time position with an anticipated start date of 12/1/2025 - 3/31/2026. The prior authorization representative is under the direct supervision of the Director of Patient Financial Services. They are responsible for ensuring that payers are prepared to reimburse RiverView Health for scheduled services in accordance with the payer-provider contract. The prior authorization representative contacts payers to request service authorizations and may collect financial and/or demographic information from patients as needed.
Primary Responsibilities
Verifies patients’ demographic, insurance, and benefits information
Obtains pre-authorization and pre-certifications from third-party payers in accordance with payer requirements, and documents the authorization number and period of validity in the EMR system (EPIC)
Gathers additional medical records from other providers as needed to support medical necessity when obtaining a pre-authorization, and follows up with payers on pre-authorization requests as needed
Alerts the clinicians involved in the patient’s care when there are issues with referrals or complications with insurance coverage
Maintains accurate records of authorizations within the EMR system (EPIC)
Identifies patients who will need to received Medicare Advance Beneficiary Notices of Noncoverage (ABNs)
Refers accounts to financial counseling as needed if authorization is not obtained
Works with business office staff to support appeal efforts for authorization-related denials
Complies with HIPAA regulations, as well as the organization’s policies and procedures regarding patient privacy and confidentiality
Maintains professional tone at all times when communicating with patients and payer representatives
Perform other duties as requested
Qualifications Education/Certifications/Licenses
Required:
High school diploma or equivalent.
1 year Prior Authorization work
Experience with EPIC EMR system
Preferred:
Associate’s degree in healthcare or business administration and/or related/comparable experience preferred
Skills and Competencies:
Working knowledge of computers, excellent communication and organization skills
Ability to work effectively in a team environment.
Ability to work with little supervision and maintain a high level of performance
Excellent organizational skills and attention to detail.
Strong communication and interpersonal skills.
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RiverView Health operates a 25 bed Critical Access Hospital, RiverView Recovery Center; a chemical dependency outpatient treatment program, RiverView Home Care and five primary care and specialty clinics in the hospitals service area.
We have a robust scholarship program for those furthering their education in a medical field, excellent benefits, and a friendly work environment. Full-time benefits include health insurance, free single vision and basic dental insurance, life insurance, long-term disability and short-term disability, and employer HSA contributions. Other benefits include employer pension matching, shift differential, incentive/premium pay, free annual biometric screening and paid volunteer time off.
RiverView is an Equal Employment Opportunity employer.
Responsibilities Prior Authorization Specialist - Temp
Schedule: Temp/Part-time (.5) - 40 hours per pay period
Scheduled Hours: Monday-Friday
Pay Range: $20.53 - $28.74 / hr (based on experience)
Job Status: Non-Exempt/Hourly, non-benefitted
This is a temporary part-time position with an anticipated start date of 12/1/2025 - 3/31/2026. The prior authorization representative is under the direct supervision of the Director of Patient Financial Services. They are responsible for ensuring that payers are prepared to reimburse RiverView Health for scheduled services in accordance with the payer-provider contract. The prior authorization representative contacts payers to request service authorizations and may collect financial and/or demographic information from patients as needed.
Primary Responsibilities
Verifies patients’ demographic, insurance, and benefits information
Obtains pre-authorization and pre-certifications from third-party payers in accordance with payer requirements, and documents the authorization number and period of validity in the EMR system (EPIC)
Gathers additional medical records from other providers as needed to support medical necessity when obtaining a pre-authorization, and follows up with payers on pre-authorization requests as needed
Alerts the clinicians involved in the patient’s care when there are issues with referrals or complications with insurance coverage
Maintains accurate records of authorizations within the EMR system (EPIC)
Identifies patients who will need to received Medicare Advance Beneficiary Notices of Noncoverage (ABNs)
Refers accounts to financial counseling as needed if authorization is not obtained
Works with business office staff to support appeal efforts for authorization-related denials
Complies with HIPAA regulations, as well as the organization’s policies and procedures regarding patient privacy and confidentiality
Maintains professional tone at all times when communicating with patients and payer representatives
Perform other duties as requested
Qualifications Education/Certifications/Licenses
Required:
High school diploma or equivalent.
1 year Prior Authorization work
Experience with EPIC EMR system
Preferred:
Associate’s degree in healthcare or business administration and/or related/comparable experience preferred
Skills and Competencies:
Working knowledge of computers, excellent communication and organization skills
Ability to work effectively in a team environment.
Ability to work with little supervision and maintain a high level of performance
Excellent organizational skills and attention to detail.
Strong communication and interpersonal skills.
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