Prior Authorization Specialist - LPN

Job Summary

Monitors incoming orders and gathers necessary documentation to ensure pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services.

Department:
Prior Authorization

Supervisor:
Admissions Manager

Supervises: none

We are committed to providing wage ranges for all open positions. Please note that the specific compensation for this role will be determined based on experience, education and internal equity considerations. The hourly wage range for this position is $22.57–$31.86. This range reflects the base salary for this position.

• Works with insurance companies and staff to obtain initial and ongoing authorizations for patients in advance of services.
  • Reviews accuracy and completeness of information requested to ensure that all supporting documents are present.
  • Provides feedback to referring provider office so patient services can be scheduled.
  • Provides authorization number to internal teams (providers, billers, etc.).
• Researches, corrects, and resubmits rejected/denied insurance authorizations.
• Communicates with patients, clinic personnel, and providers over the phone, via email or other written documentation and responds to all inquiries.
• Utilizes and maintains online prior authorization software.
• Serves as a liaison between the prior auth team, ordering providers, nursing staff and care coordination teams.
• Conducts clinically informed review of provider orders, documentation, and medical records to determine medical necessity based on payer guidelines and evidence-based criteria.
• Identifies missing, insufficient, or inconsistent clinical information and proactively obtains clarifications from providers.
• Reviews denial trends and recommends clinical-focused process improvements to reduce avoidable denials.

• High School diploma or equivalent
• Current LPN license with the Minnesota Board of Nursing, in good standing
• Must be able to speak, read, and write English proficiently to ensure safe and effective communication in a healthcare environment
• Previous customer service experience
• General computer skills and experience
• Ability to work in a high volume/fast-paced environment

• Prior authorization knowledge/experience

• Monday-Friday 8:30am-5:00pm
• Onsite at Northfield Hospital with potential for some hybrid work after initial training period.

• Paid Time Off accrued starting on first paycheck
• Medical, Dental, and Vision (discount plan) coverage
• Flexible Spending Accounts
• Life, AD&D, and Disability Insurance
• Pension Plan (PERA) with 7.5% employer match
• Optional 457(b) Retirement Plans
• Tuition Reimbursement
• Loan Forgiveness Eligibility – PSLF + MN state programs for qualifying roles
• Employer-Provided Certifications + Continuing Education
• Additional perks:
  Free On-Site Parking, Qualified Bilingual Staff Program, Employee Assistance Program, and discounts on cafeteria, scrubs, and OTC pharmacy items

Northfield Hospital + Clinics is a trusted, independent healthcare system with more than 800 employees. We’re recognized for our collaborative work environment and strong commitment to high-quality patient care and community impact. We’re proud to be named to Becker’s 2025 list of "100 Great Community Hospitals." Our services span the full spectrum of hospital and clinical care, with our main hospital located in Northfield, MN, and primary and specialty clinics in Northfield, Lakeville, Farmington, Faribault, and Kenyon—along with Urgent Care locations in Northfield, Lakeville, and Farmington.

We offer care across 48 specialties and serve patients at 22 locations throughout the south metro and southern Minnesota.

Whether you're just starting your career or bringing years of experience, you'll find meaningful opportunities, supportive teams, and a chance to make a real difference here.