Prior Authorization & Referral Coordination Specialist

St. Charles Health System; United States; Remote; USD 31,000 - 41,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

403(b) retirement plan

Earned Time Off

Job summary

St. Charles Health System seeks a Prior Authorizations and Referral Management Representative to coordinate prior authorizations and referrals across outpatient services. You will liaise with patients, providers, and payers to ensure timely access and accurate coverage, with extensive scheduling support for surgery and specialty care.

This full-time role offers a competitive hourly pay range and comprehensive benefits, including medical, dental, vision, a 403(b) plan and Earned Time Off.

Qualifications

• Requires a High School diploma or GED
• College level coursework preferred
• Minimum of one year experience in hospital/clinic/medical insurance billing
• Basic understanding of medical coding
• Proficiency with electronic medical records and standard office software

Responsibilities

• Multitask and prioritize workflows; engage providers, care team, and patients in the prior authorization process
• Confirm and validate patient health plan coverage and obtain accurate benefits eligibility
• Communicate provider, facility, and order information to health plan
• Coordinate and support providers with medication authorizations
• Utilize internal and external systems to request and coordinate prior authorizations and referrals
• Schedule patients with internal and external departments, clinics, and hospitals
• Maintain accurate information in systems about requests for prior authorizations and referrals
• Assist with patient education and follow up regarding prior authorizations and referrals

Skills

Customer service

Communication

Multitasking

Organization

Education

High school diploma or GED

College coursework preferred

Tools

EMR system

MS Office

MS Teams

Excel

Job description

St. Charles Health System seeks a Prior Authorizations and Referral Management Representative to coordinate prior authorizations and referrals across outpatient services. You will liaise with patients, providers, and payers to ensure timely access and accurate coverage, with extensive scheduling support for surgery and specialty care.

This full-time role offers a competitive hourly pay range and comprehensive benefits, including medical, dental, vision, a 403(b) plan and Earned Time Off.