Patient Authorization & Referral Representative

Actalent; Spokane Valley (WA); On-site; USD 32,000 - 36,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Paid time off (PTO)

Job summary

Actalent is seeking a Patient Authorization & Referral Representative in Spokane Valley, WA. You will verify insurance benefits and eligibility for referrals, perform ongoing verifications for Medicaid and Hospice patients, and assist in determining therapy coverage.

You will also create Cost Disclosure and ABN forms, maintain accurate patient and physician records in the EMR, and support QA initiatives in a fast-paced infusion pharmacy environment.

Qualifications

• Experience in healthcare settings (1+ year) required.
• Proficiency with insurance verification and preauthorizations.
• Experience with EPIC or similar EMR systems.
• Strong written and verbal communication skills.
• Typing accuracy and speed.

Responsibilities

• Verify insurance benefits and eligibility for new referrals.
• Perform monthly verification for long-term Medicaid patients.
• Verify weekly verification for capitated Hospice patients.
• Evaluate documentation for therapy coverage eligibility.
• Create Cost Disclosure/ABN forms and track signed docs.
• Enter patient and physician data into the database.
• Obtain and follow up on PCP referral requests.
• Document payer/billing information in records.
• Obtain initial pre-authorizations as required.
• Support QA and QI activities.
• Perform Medicare Part D eligibility and drug formulary checks.
• Prepare hospital charity agreements and manage financial assistance apps.

Skills

Medical terminology

Customer service

Insurance verification

Prior authorization

Healthcare experience

EPIC EMR

Education

High school diploma or GED

Tools

EPIC EMR

Job description

Job Title: Patient Authorization & Referral Representative

Job Description

We are seeking a dedicated Patient Authorization & Referral Representative to join our team. In this role, you will be responsible for verifying insurance benefits and eligibility for new referrals, performing monthly and weekly verifications for specific patient groups, and assisting in evaluating documentation for therapy coverage. You will also handle the creation of Cost Disclosure and benefits letters, manage patient and physician data entry, and ensure accurate documentation in patient electronic records.

Responsibilities

• Verify insurance benefits and eligibility for all new referrals.
• Perform monthly verification of DSHS coverage for long-term Medicaid patients and weekly verification for capitated Hospice patients.
• Assist in evaluating documentation to determine if patients meet criteria for therapy coverage.
• Gather and ensure the accuracy and completeness of forms and reports, addressing any omissions or errors.
• Create Cost Disclosure/Advance beneficiary notices for Medicare patients and track signed forms.
• Generate benefits letters to inform patients of financial responsibility.
• Enter new patient and physician data into the software database, including therapy sessions and ICD-9/ICD-10 codes.
• Obtain and follow-up on PCP referral requests.
• Document payer/billing information in patient electronic records.
• Obtain initial pre-authorizations as required by insurance plans.
• Verify physician licensure on an ongoing basis.
• Support the Mission in daily activities.
• Participate in Quality Assurance and Quality Improvement activities.
• Perform Medicare Part D eligibility and drug formulary checks.
• Prepare hospital charity agreements and manage patient financial assistance applications.

Essential Skills

• Medical terminology
• Customer service
• Insurance verification
• Prior authorization
• 1+ year experience in a healthcare setting
• Experience with EPIC or similar EMR systems

Additional Skills & Qualifications

• One year+ reimbursement experience
• One year+ verification/insurance benefits experience
• Ability to type quickly and accurately
• Effective written and oral communication skills
• General computer skills, including word processing, spreadsheets, and database software
• Knowledge of office equipment
• High school diploma or GED

Work Environment

This position is based in an infusion pharmacy/office setting. The role involves working with various technologies and requires a collaborative team player who is a quick learner, given the dynamic and challenging nature of the work.

Job Type & Location

This is a Contract to Hire position based out of Spokane Valley, WA.

Pay And Benefits

The pay range for this position is $23.00 - $26.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

Job Type & Location

This is a Contract to Hire position based out of Spokane Valley, WA.

Application Deadline

This position is anticipated to close on Nov 9, 2026.

Workplace Type

This is a fully onsite position in Spokane Valley,WA.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email [e-mail] for other accommodation options.

San Francisco Fair Chance Ordinance

Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI)

We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.'