Prior Authorization & Referral Specialist

St. Charles Health System; Bend (OR); On-site; USD 40,000 - 60,000; Full time

Job summary

St. Charles Health System in Bend, Oregon, seeks a Prior Authorizations and Referral Management Representative to coordinate prior authorization and referral processes for services, testing, specialty care, and surgery.

The role involves extensive scheduling with the surgery department, specialists and ancillary departments and serves within Patient Access Services. The ideal candidate will have at least one year of hospital/clinic billing experience, basic knowledge of medical coding, a high

Qualifications

• Must multitask and prioritize workflows, engaging providers, care team, and patients in prior authorization.
• Verifies and validates patient health plan coverage; updates coverage and benefits accurately.
• Communicates provider, facility, and order information to health plan during authorization and referrals.

Responsibilities

• Notifies health plan and gains financial clearance for plans needing authorization.
• Coordinates and supports providers with medication authorizations.
• Uses internal and external systems to request and coordinate prior authorizations and referrals.

Skills

Multitasking

Scheduling coordination

Communication with providers/patients

Health insurance billing knowledge

Attention to detail

Education

High School diploma or GED

Job description

St. Charles Health System in Bend, Oregon, seeks a Prior Authorizations and Referral Management Representative to coordinate prior authorization and referral processes for services, testing, specialty care, and surgery.

The role involves extensive scheduling with the surgery department, specialists and ancillary departments and serves within Patient Access Services. The ideal candidate will have at least one year of hospital/clinic billing experience, basic knowledge of medical coding, a high