Patient Authorization and Referral Representative - Scheduling

Providence Health & Services; Seattle (WA); On-site; USD 49,000 - 74,000; Full time

Benefits offered by this job

Health benefits

Retirement plan

On-site work

Job summary

Providence Swedish is seeking a Prior Authorization Specialist to support processing of medication prior authorizations for clinic patients. You will act as a liaison among physicians, pharmacies, clinic staff and insurance carriers to ensure timely, accurate authorizations.

The role requires 2 years’ experience in a medical/managed care setting; a related Bachelor's degree is preferred. Epic experience is a plus as you work across multiple teams to support patient care.

Qualifications

• 2 years experience in a medical clinic or managed care/health insurance plan within the past 2 years.
• Bachelor's degree in a related field is preferred.

Responsibilities

• Demonstrates proficiency in core functions of prior authorizations, appeals, audits, and training.
• Provides technical assistance to clinic staff and physicians on patient coverage and guidelines.
• Navigates insurer websites to obtain prior authorization requirements and protocols.
• Receives and triages calls from pharmacies and clinics seeking assistance.
• Processes documentation for prior authorizations via fax, portals, and phone.
• Verifies member eligibility as needed and coordinates information with clinics and pharmacies.
• Reviews patient charts to gather documentation showing medical necessity and benefit details.
• Requests additional clinical information from clinics to facilitate medical review.

Skills

Medical clinic experience

Insurance knowledge

Education

Bachelor's degree in related field

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.

About Providence

At Providence, our strength lies in Our Promise of \"Know me, care for me, ease my way.\" Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts 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.

Providence 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. 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.

Requsition ID: 461550

Company: Swedish Jobs

Job Category: Patient Access

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Day

Career Track: Admin Support

Department: 3908 SCHEDULING WA

Address: WA Seattle 1730 Minor Ave

Work Location: Swedish Metropolitan Park East-Seattle

Workplace Type: On-site

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.