Care Access & Prior Authorization Specialist

St. Luke’s University Health Network; Bethlehem (Northampton County); On-site; USD 38,000 - 54,000; Full time

Job summary

St. Luke's University Health Network is seeking a Practice Prior Authorization and Referral Specialist to coordinate prior-authorizations and referrals for specialty care, medications, and diagnostics.

The role includes insurance verification, obtaining pre-authorizations, scheduling and referrals, and notifying providers of denials or peer-to-peer needs. Strong knowledge of ICD-10 and CPT codes is preferred.

Qualifications

• High school diploma or equivalent required.
• Prior authorization experience preferred.
• 1–2 years of experience in medical billing, a medical office or insurances preferred.
• Knowledge of ICD-10 and CPT codes; understanding of medical office procedures.

Responsibilities

• Receive requests for specialty care through EHRs, provider orders, phone, or fax.
• Verify patient demographics and insurance information for accuracy.
• Review insurance eligibility and obtain prior authorization for services.
• Obtain and document prior authorization to ensure proper reimbursement.
• Coordinate with central scheduling and other departments.
• Respond to inquiries from patients, insurers, pharmacies, and other departments.

Skills

Prior authorizations

Insurance verification

Customer service

Scheduling

Education

High school diploma or equivalent

Tools

EHR systems

Medical billing software

Job description

St. Luke's University Health Network is seeking a Practice Prior Authorization and Referral Specialist to coordinate prior-authorizations and referrals for specialty care, medications, and diagnostics.

The role includes insurance verification, obtaining pre-authorizations, scheduling and referrals, and notifying providers of denials or peer-to-peer needs. Strong knowledge of ICD-10 and CPT codes is preferred.