Patient Authorization and Referral Representative - Scheduling

Providence-Swedish-; Seattle (WA); On-site; USD 32,000 - 49,000; Full time

Benefits offered by this job

401k matching

Medical benefits

Paid time off

Job summary

Providence Swedish is seeking a Prior Authorization Specialist to facilitate processing of medication prior authorizations for clinic patients in accordance with guidelines. This role acts as a liaison among physicians, pharmacies, clinic staff and insurance carriers to ensure high-quality service.

Join a not-for-profit health care system committed to patient-centered care and collaborative teamwork. The position offers comprehensive benefits and opportunities to grow within Swedish Medical

Qualifications

• 2 years experience in a medical clinic or managed care/health insurance plan within the past 2 years.
• 2 years experience in an area such as prior authorizations, medical audits, appeals or delegation.
• 1 year Epic software experience.

Responsibilities

• Demonstrates proficiency in the core functions of one or more medication prior authorization areas, including prior authorizations, appeals, audits, and training.
• Serves as a resource for the Prior Authorization Service by providing technical assistance to clinic staff and physicians regarding patient coverage, authorization guidelines and procedures, claims research, and departmental operating procedures.
• Utilizes and navigates various insurance company websites to obtain medication prior authorization requirements and protocols.
• Receives, triages, and responds appropriately to phone calls from pharmacies and clinics seeking assistance.
• Processes all documentation and forms related to medication prior authorizations, including submissions via fax, online portals, and telephone.
• Verifies member eligibility as necessary to process medication prior authorizations and collaborates with clinic staff and pharmacies to obtain required information.
• Reviews patient charts to gather documentation supporting the medical necessity of requested medications. Completes prior authorization requests by incorporating relevant clinical information and benefit details, including plan limitations and exclusions, to support the medical review process.
• Contacts clinics to obtain additional clinical information, such as chart notes and diagnostic results, as needed to facilitate the medical review process.

Skills

Medical clinic exp

Prior authorizations

Communication skills

Education

Bachelor's degree

Tools

Epic software

Job description

Description

The Prior Authorization Specialist facilitates processing of medication prior authorizations for clinic patients in accordance with established guidelines. This position serves as a liaison between physicians, pharmacies, clinic staff and insurance carriers to assure high quality service to Swedish patients and clinics.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Swedish Health Services DBA Swedish Medical Group and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Duties and Responsibilities

• Demonstrates proficiency in the core functions of one or more medication prior authorization areas, including prior authorizations, appeals, audits, and training.
• Serves as a resource for the Prior Authorization Service by providing technical assistance to clinic staff and physicians regarding patient coverage, authorization guidelines and procedures, claims research, and departmental operating procedures.
• Utilizes and navigates various insurance company websites to obtain medication prior authorization requirements and protocols.
• Receives, triages, and responds appropriately to phone calls from pharmacies and clinics seeking assistance.
• Processes all documentation and forms related to medication prior authorizations, including submissions via fax, online portals, and telephone.
• Verifies member eligibility as necessary to process medication prior authorizations and collaborates with clinic staff and pharmacies to obtain required information.
• Reviews patient charts to gather documentation supporting the medical necessity of requested medications. Completes prior authorization requests by incorporating relevant clinical information and benefit details, including plan limitations and exclusions, to support the medical review process.
• Contacts clinics to obtain additional clinical information, such as chart notes and diagnostic results, as needed to facilitate the medical review process.

Required Qualifications

• 2 years experience in a medical clinic or managed care/health insurance plan within the past 2 years

Preferred Qualifications

• Bachelor's degree in a related field
• 2 years experience in an area such as prior authorizations, medical audits, appeals or delegation
• 1 year Epic software experience

Why Join Providence

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission of improving the health and wellbeing of each patient we serve.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

About the Team

Providence Swedish is the largest not-for-profit health care system in the greater Puget Sound area. It is comprised of eight hospital campuses (Ballard, Edmonds, Everett, Centralia, Cherry Hill (Seattle), First Hill (Seattle), Issaquah and Olympia); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Providence Swedish Medical Group, a network of 190+ primary care and specialty care locations throughout the Puget Sound. Whether through physician clinics, education, research and innovation or other outreach, we’re dedicated to improving the wellbeing of rural and urban communities by expanding access to quality health care for all.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern.

Pay Range: $23.39 - $35.78. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more.