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Overnight Prior Authorization Rn Jobs in Wisconsin

Actalent

RN Care Manager

Milwaukee, WI · On-site

Job Title: RN Care Manager The RN Care Manager provides comprehensive clinical assessment, develops ... Utilize healthcare management systems and processes for case management, prior authorization, and ...

Actalent

RN Care Manager

Milwaukee, WI

Job Title: RN Care Manager The RN Care Manager provides comprehensive clinical assessment, develops ... Utilize healthcare management systems and processes for case management, prior authorization, and ...

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Overnight Prior Authorization Rn information

What is an Overnight Prior Authorization RN?

An Overnight Prior Authorization RN is a Registered Nurse who works overnight shifts to review and process requests for prior authorization of medical services, procedures, or medications. Their role involves evaluating clinical documentation to determine if requested treatments meet insurance or organizational guidelines for approval. These nurses collaborate with providers, patients, and insurance companies to ensure timely and appropriate care. Working overnight allows for 24/7 coverage, supporting urgent cases and maintaining continuous workflow in healthcare authorization departments.

What are the key skills and qualifications needed to thrive as an Overnight Prior Authorization RN?

To thrive as an Overnight Prior Authorization RN, you need a current RN license, strong clinical judgement, and in-depth knowledge of insurance guidelines and medical necessity criteria. Familiarity with prior authorization software, electronic health records (EHR), and payer-specific systems is typically required. Exceptional attention to detail, critical thinking, and effective communication skills are vital for navigating complex cases and collaborating remotely. These skills ensure timely and accurate authorization decisions, supporting patient care and compliance during overnight shifts.

What are some unique challenges faced by Overnight Prior Authorization RNs, and how can they effectively manage them?

Overnight Prior Authorization RNs often work independently with limited immediate support, which can present challenges such as handling complex cases without direct peer consultation and maintaining focus during non-traditional hours. They must be adept at managing high volumes of authorization requests, prioritizing urgent cases, and communicating effectively with providers and insurance companies outside regular business hours. Staying organized, utilizing clear documentation, and leveraging electronic health record systems can help manage workload efficiently. Building strong relationships with day-shift colleagues for smooth case handoffs is also crucial for success in this role.

What is the difference between Overnight Prior Authorization Rn vs Medical Assistant?

AspectOvernight Prior Authorization RnMedical Assistant
CredentialsRegistered Nurse (RN) licensePost-secondary certificate or diploma
Work EnvironmentHospitals, clinics, insurance companiesDoctor's offices, clinics, outpatient facilities
Job FocusReviewing insurance authorizations, patient advocacyAssisting with patient care, administrative tasks

The Overnight Prior Authorization RN primarily handles insurance approvals and patient advocacy during overnight shifts, requiring RN licensure. In contrast, Medical Assistants focus on direct patient care and administrative support in outpatient settings. While both roles support healthcare operations, their credentials, responsibilities, and work environments differ significantly.

What are the most commonly searched types of Prior Authorization Rn jobs in Wisconsin?

The most popular types of Prior Authorization Rn jobs in Wisconsin are:

What cities in Wisconsin are hiring for Overnight Prior Authorization Rn jobs?

Cities in Wisconsin with the most Overnight Prior Authorization Rn job openings:

Overnight Prior Authorization Rn jobs near you

Medical Coding & Prior Authorization Specialist

CROSSING RIVERS HEALTH

Prairie Du Chien, WI • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 26 days ago

Job description

Medical Coding & Prior Authorization Specialist Full Time / Days / On-Site 40 hours per week Come join our team! Crossing Rivers Health provides competitive pay along with an excellent benefits package including medical, dental, vision; life insurance, short term disability, paid time off, a retirement plan w/company match, and more! Crawford County Relocation Opportunity - Talent Recruitment Grant Crossing Rivers Health is excited to partner with Driftless Development, Inc. to secure the newly awarded Talent Recruitment Grant by Wisconsin Economic Development Corporation (WEDC). Come Home to River Country is an initiative designed to attract and retain talent by offering a relocation incentive for out-of-state households moving to Crawford County, Wisconsin. Click here for more information. Driftless Development Our core values are practiced and exhibited throughout the organization in our actions and in services provided. Joy : Unity : Integrity : Compassion : Excellence The Medical Coding and Prior Authorization Specialist plays a dual role in supporting accurate clinical documentation and ensuring timely authorization of services for patients at Crossing Rivers Health. This position is responsible for coding all/assigned encounter types; reviewing and correcting coding related denials and managing prior authorization processes for specialty services, surgical procedures, therapies and imaging. The goal of this role is to support compliance, maximize reimbursement and ensure patients have timely access to medically necessary care. Essential Job Functions
  • Reviews clinical documentation to ensure coding accuracy, completeness, and compliance with regulations.
  • Assigns diagnoses, procedural/treatment, professional billing codes for all patient type encounters (Clinic, Center for Specialty Care, Emergency, Urgent Care, Outpatient Services, Lab, Imaging, Physical/Occupational/Speech Therapy, Surgery, Observation/Inpatient, Obstetrics) utilizing ICD-10-CM, ICD-10-PCS or CPT guidelines
  • Working knowledge of modifier usage, CCI edits, HCPCS, LCD/NCI regulations
  • Data entry/verification/appropriate sequencing into electronic health record
  • Submit provider queries as appropriate following approved guidelines.
  • Identify and resolve clinical documentation and charge capture data discrepancies
  • Initiates and manages prior authorization requests for surgical procedures, specialty services, imaging, and rehabilitation therapies.
  • Verifies medical necessity and payer-specific criteria prior to submission of authorization requests.
  • Assists with denial follow-up and appeals related to coding or prior authorization
  • Collaborates with providers, nursing staff, and scheduling teams to obtain required clinical documentation for approvals.
  • Monitors pending authorizations, ensuring timely follow-up and communication with payers, providers, and patients.
  • Tracks and reports trends in authorization denials and coding discrepancies; participates in denial prevention initiatives.
  • Maintains current knowledge of payer guidelines, coding updates, and regulatory requirements.
  • Supports staff and providers through education on documentation and authorization best practices.
  • Contributes to a culture of accountability, continuous improvement, and patient-centered service.
  • Assist in provider education in use of coding guidelines and practices and proper documentation techniques
  • Assist with coding quality review activities for accuracy and compliance monitoring
  • Commitment to continuous learning as required to stay up-to-date on coding and prior authorization guidelines.
  • Other job duties and responsibilities as assigned to effectively meet the needs of the patients, the department, and the organization as a whole.
Competencies
  • Accountability - Ability to accept responsibility and account for his/her actions.
  • Accuracy - Ability to perform work accurately and thoroughly.
  • Business Acumen - Ability to grasp and understand business concepts and issues.
  • Communication - The ability to get one's ideas across to others through oral or written means and to understand the ideas of others through effective listening skills.
  • Detail Oriented - Ability to pay attention to the minute details of a project or task.
  • Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
  • Honesty/ Integrity - Ability to be truthful and be seen as credible in the workplace.
  • Organized - Possessing the trait of being organized or following a systematic method of performing a task.
  • Reliability - The trait of being dependable and trustworthy.
  • Responsible - Ability to be held accountable or answerable for one's conduct.
Reasonable Accommodations Statement To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions. Requirements Education
  • High School Graduate or General Education Degree (GED) : Required
  • Associate's Degree in Health Information Management, Medical Coding, OR related/Medical Coding diploma/educational program: Required
  • Registered Health Information Technician or related Medical Coding certification within 6 months of hire.
Experience
  • 2+ years of medical coding experience in a Critical Access Hospital or similar setting preferred.
  • Prior authorization and insurance verification experience preferred.
Computer Skills
  • Proficient in Microsoft Office
  • Epic experience preferred

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