Pharmacy Referral & Pre-Authorization Specialist

EvergreenHealth; Kirkland (WA); On-site; USD 34,000 - 55,000; Full time

Benefits offered by this job

Washington Paid Sick Leave

457(b) retirement plan

Free parking

Cafeteria & Gift Shop Discount

Job summary

EvergreenHealth is seeking a Patient Service Representative to coordinate patient referrals from primary care providers to pharmacist specialty services and to process pre-authorizations for medications and services. You will work closely with health plans and healthcare providers to ensure accurate coding and timely referrals.

The role requires daily interaction with patients, staff, and insurers, and offers opportunities to handle complex cases within a collaborative per diem team environment

Qualifications

• Associates degree or equivalent required.
• 2 years of healthcare insurance or medical office experience.
• Strong knowledge of ICD-10 and CPT codes.
• Excellent communication and interpersonal skills.

Responsibilities

• Coordinate patient referrals from PCPs to specialists, interfacing with health plans.
• Process medical and pharmacy pre-authorizations for department services.
• Assign ICD-10/CPT codes to referrals and communicate contractual requirements.
• Interact daily with patients, providers, and insurers to resolve issues.

Skills

Clear communication

Professionalism

Team collaboration

Education

Associate degree or equivalent

Tools

ICD-10 codes

CPT codes

Medical billing software

Job description

EvergreenHealth is seeking a Patient Service Representative to coordinate patient referrals from primary care providers to pharmacist specialty services and to process pre-authorizations for medications and services. You will work closely with health plans and healthcare providers to ensure accurate coding and timely referrals.

The role requires daily interaction with patients, staff, and insurers, and offers opportunities to handle complex cases within a collaborative per diem team environment