Prior Authorization & Referral Coordinator

St. Charles Health System; Bend (OR); On-site; USD 40,000 - 55,000; Full time

Job summary

St. Charles Health System in Bend, Oregon seeks a Prior Authorizations and Referral Management Representative to coordinate authorizations and referrals for services, testing, specialty care, diagnostics, and surgery.

This role acts as a liaison between patients and clinicians to facilitate care coordination. You will perform scheduling coordination with surgery, clinics, and ancillary departments, update systems with eligibility and approvals, and support patient education while maintaining

Qualifications

• Minimum one year in hospital, clinic, or medical insurance billing office.
• Basic understanding of medical coding.
• High school diploma; college coursework preferred.

Responsibilities

• Coordinate prior authorization and referrals for services, testing, specialty care, diagnostics and surgery.
• Validate patient health plan coverage and obtain accurate benefit eligibility in the system.
• Communicate provider, facility, and order information to health plans.
• Notify health plans and obtain financial clearance for planned care.
• Coordinate patient assistance programs with patients and providers.
• Utilize internal and external systems to request and coordinate prior authorizations and referrals.

Skills

Medical billing

Pre-authorization

Claims processing

Healthcare admin

Customer service

Education

High School Diploma

College coursework preferred

Tools

EHR systems

Insurance portals

Scheduling software

Job description

St. Charles Health System in Bend, Oregon seeks a Prior Authorizations and Referral Management Representative to coordinate authorizations and referrals for services, testing, specialty care, diagnostics, and surgery.

This role acts as a liaison between patients and clinicians to facilitate care coordination. You will perform scheduling coordination with surgery, clinics, and ancillary departments, update systems with eligibility and approvals, and support patient education while maintaining