Network Prior Authorization and Referral Specialist, Full Time

St. Luke’s University Health Network; Allentown (Lehigh County); On-site; USD 22,000 - 30,000; Full time

Job summary

St. Luke's University Health Network is seeking a capable professional to manage pre-registration, prior authorizations, and referrals across Primary Care and Specialty services. You will verify patient data, coordinate with payers, and support accurate billing in a fast-paced hospital setting.

Strong customer service, independence, and proficiency with Epic are required to ensure timely reimbursements and smooth patient flow. This role emphasizes accuracy and collaboration with clinical staff.

Qualifications

• High school graduate or equivalent required.
• Minimum three years in a healthcare office/department setting preferred.
• Strong customer service skills and ability to work independently are essential.
• Computer experience and ability to use electronic health record workflows required.

Responsibilities

• Handle accurate and timely pre-registration for St. Luke's Primary Care and Specialty practices.
• Submit prior authorizations and insurance referrals for specified departments.
• Verify and validate patient financial information and ensure proper reimbursement.
• Notify providers and scheduling teams of authorization requirements and denials as needed.

Skills

Customer service

Independent work

Computer proficiency

Education

High school diploma or equivalent

Tools

Epic

Epic Work Queues

Job description

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.Responsible for accurate and timely pre-registration, submission of prior authorizations for SLPG Primary Care and Specialty practices, submission of insurance referrals for all Primary Care and Care Now departments, peer to peer evaluations, verification and validation of all financial information, and Point of Service cash collection for all services assigned to ensure proper reimbursement.JOB DUTIES AND RESPONSIBILITIES:R e sponsible for the finan c ial c le a r a n c e of a ll s c h e duled p a ti e nts b y p ro v i d ing a c c u ra te a nd timely v e ri f ic a tion of a ll fin a n c i a l info r mation a nd p rec e rtifi ca tion/r e fer r a l f o r a ll s e rvi c e s to e nsure p r op e r r e imburs e ment.Responsible for reviewing medical necessity of genetic testing/infusion services in addition to prior authorization to ensure revenue for services.Monitors a ll hospital sch e duled diagnostic and surgical appointments to ensure that a ll ca s e s a re i d e ntified, a nd fin a n c ial c l ea r a n c e is obtain e d.Submit prior authorizations for all STAT imaging orders for PCP and Specialty prior to date of service.Submit for insurance referrals for all PG Specialty and PCP orders and SL Care Now Departments.Submit prior authorizations for diagnostic orders placed by PG PCP and Specialty service lines.Utilizes specific Epic Work Queues designed for Prior Authorization and Insurance Referral workflows to ensure correct process is followed for proper documentation and billing in Epic.Notifies all external providers of prior authorization requirements for scheduled services.Notifies practices of all denied authorizations via in-basket message and provide peer to peer info for scheduling.Review payer medical policies and contact the health plan’s UR department for first attempt appeal mitigation.PHYSICAL AND SENSORY REQUIREMENTS:Sitting up to e i g ht (8) hours p e r d a y , three (3) h ours a t a time. Consiste n t use of h a nds a nd fin g e rs for ty pi n g , tel e pho n e s, d a ta e nt r y , e tc. O c c a sional t w isting a nd turni n g . U s e s upp e r e x tr e miti e s to lift a nd ca r r y up to 15 pounds. Stoops, b e nds a nd r e ac h e s a bove should e r le v e l to r e trieve files. He a ri n g a s it r e lat e s to no r mal c on v e r s a tion. S ee ing a s it re lat e s to g e n e r a l vision.EDUCATION:Hi g h sc h ool g r a du a te o r e quival e nt.TRAINING AND EXPERIENCE:Three years healthcare experience in a department or office with a hospital, p h y sici a n ’s o f fi c e , or simil a r medi ca l f a c ili t y preferred. It is required to have at least one year in areas stated above. Strong c ustom e r s e rvi c e skills with kn o wl e d g e of h ea lth insur a n ce s required. M u st h a ve a bili t y to w o rk i n d e p e nd e nt l y . Comput e r e x p e ri e n c e r e qu i r e d. B ilin g u a l p re fer r e d.Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!St. Luke's University Health Network is an Equal Opportunity Employer.