Healthcare Referral & Authorization Specialist

Praxis-Health; Bend (OR); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

401(K) with discretionary employer

Paid Time Off

Free clinical diagnostics

Job summary

Praxis Health is seeking a detailed Referrals and Prior Authorizations Coordinator to support High Lakes Health Care’s team in Bend, OR. You will coordinate referrals and authorizations for specialty services, review insurance requirements, and submit requests through payer portals and systems.

The ideal candidate has 2+ years in healthcare, solid knowledge of payer requirements, and strong accuracy in documentation.

Qualifications

• High school diploma required; prefer Associate/Bachelor in healthcare administration, health information management, medical assisting, or related field.
• 2+ years of healthcare experience preferred, especially referrals, prior authorizations, billing, insurance verification, or patient access.
• Knowledge of health insurance plans, referral requirements, prior authorization processes, and payer guidelines preferred.
• Experience with EHR and practice management systems, and with insurance/payer portals.
• Familiarity with medical terminology, codes, and healthcare workflows.
• Experience communicating with insurers, providers, and outside facilities preferred.

Responsibilities

• Process referrals and prior authorizations for specialty care, imaging, procedures, medications, and other services.
• Review insurance coverage to determine referral and authorization requirements and network restrictions.
• Submit referrals and prior authorizations through payer portals, electronic systems, phone, or fax.
• Review orders and documentation for completeness and request additional info as needed.
• Gather and submit chart notes, imaging results, insurance information, and other records.
• Communicate with providers, insurers, pharmacies, and facilities to resolve issues.
• Track pending referrals/authorizations and follow up with payers or facilities for timely processing.
• Document approvals, denials, or requests for more information from payers.
• Redirect referrals when needed due to network restrictions or availability.
• Maintain accurate documentation in the EHR/practice management system.
• Explain status and requirements to clinical teams and staff.
• Keep up-to-date with payer policies and workflow changes.
• Prioritize workload based on urgency and departmental procedures.
• Follow department policies for consistent processing.

Skills

Referral processing

Authorization processing

Insurance verification

Payer guidelines

Documentation accuracy

Communication

Time management

HIPAA compliance

Education

Associate/Bachelor in healthcare field

Tools

EHR systems

Practice management systems

Payer portals

Insurance portals

Job description

Praxis Health is seeking a detailed Referrals and Prior Authorizations Coordinator to support High Lakes Health Care’s team in Bend, OR. You will coordinate referrals and authorizations for specialty services, review insurance requirements, and submit requests through payer portals and systems.

The ideal candidate has 2+ years in healthcare, solid knowledge of payer requirements, and strong accuracy in documentation.