Pre-Authorization Rep

CommonSpirit Health; Bremerton (WA); On-site; USD 52,000 - 62,000; Full time

Job summary

Virginia Mason Franciscan Health is seeking a Pre-Authorization Rep to ensure seamless access to prescribed therapies by coordinating with infusion centers, physician offices, and insurance providers. You will manage pre-authorizations for specialty medications and navigate insurance requirements to minimize delays in patient care.

Responsibilities include reviewing patient records in Epic, communicating with medical providers, and partnering with billing to resolve denials.

Qualifications

• Two years of related work experience demonstrating requisite job knowledge and abilities.
• Ability to interpret regulatory guidelines including HIPAA compliance and maintain accuracy in documentation.

Responsibilities

• Monitor work queues and verify insurance coverage to secure necessary authorizations.
• Review patient records in Epic to identify documentation needs and communicate with providers.
• Collaborate with the billing department to resolve insurance denials and delays.
• Stay current on payer requirements, market conditions, and medication availability to support patients.

Skills

Insurance billing

Medical terminology

Job description

Job Summary and Responsibilities

As our Pre-Authorization Rep, you will play a vital role in the patient experience by ensuring seamless access to necessary medical treatments. You will act as a key liaison between our infusion center, physician offices, and insurance providers, managing the critical pre-authorization process for specialty medications. By expertly navigating insurance requirements, coding protocols, and medical documentation, you will help minimize delays and ensure that our patients receive their prescribed therapy in a timely and efficient manner.

Every day you will monitor work queues, verify insurance coverage, and secure necessary authorizations to facilitate patient care. You will be responsible for reviewing patient records in Epic to identify clinical documentation needs, communicating directly with medical providers, and collaborating with our billing department to resolve insurance denials. Furthermore, you will stay current on evolving market conditions, payer requirements, and medication availability to provide proactive support to our patients, including researching resources to assist with high-cost medication needs.

To be successful in this role, you will bring at least two years of related work experience and a strong background in insurance billing and medical terminology. You should possess the ability to interpret complex regulatory guidelines, including HIPAA compliance, and maintain the highest levels of accuracy in documentation. With your exceptional customer service skills, proficiency in automated healthcare systems, and the ability to prioritize tasks in a fast-paced environment, you will be an essential part of our team’s commitment to providing high-quality, compassionate care.

Job Requirements

• Two years of related work experience that demonstrates attainment of the requisite job knowledge and abilities.
• None, upon hire

Where You'll Work

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.

Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person - body, mind, and spirit - in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.

Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.

We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.