Prior Authorization & Referral Specialist

Paycom; South Bend (WA); On-site; USD 36,000 - 58,000; Full time

Benefits offered by this job

Medical

Dental

Vision

403b Retirement

Job summary

Willapa Harbor Hospital in South Bend, WA is seeking a dedicated Insurance Authorization Specialist to manage organization-wide prior authorizations and coordinate referrals for medical procedures and services.

Responsibilities include verifying coverage, interpreting medical necessity guidelines, submitting clinical documentation to payers, maintaining accurate EHR updates, and communicating with patients, providers, and insurers to ensure timely, coordinated care across departments.

Qualifications

• High school diploma or equivalent.
• Two years' experience with prior authorizations preferred.
• Strong knowledge of insurance processes including Medicare, Medicaid, and commercial plans.
• Understanding of medical necessity guidelines.
• Good communication, organization and multitasking skills.
• Familiarity with ICD-10 and CPT codes.
• Ability to read and interpret clinical notes.
• Ability to work collaboratively across departments.

Responsibilities

• Verify patient insurance eligibility and benefits and determine whether authorization is required for specific services.
• Obtain, track, and manage prior authorizations (for imaging, procedures, specialists' and admissions).
• Examine medical records to compile necessary supporting documentation for requests.
• Submit clinical documentation to insurance payers.
• Process and track outgoing referrals, ensuring all required documentation is sent to specialist and tracking outcomes.
• Maintain accurate EHR updates. Document all progress in the referral.
• Document progress and follow through on referrals.
• Maintain detailed records of all authorization requests, approvals, and denials for compliance and audit purposes.
• Communicate with patients, providers, and insurers.
• Work as a part of an integrated team comprised of Patient Access, Patient Accounts, providers, and patients.
• Act as a liaison between all parties involved.
• Notify healthcare providers and clinical staff of authorization approvals, denials, or required modifications.
• Additional duties as assigned.

Skills

Insurance processes

Communication

Organization

Multitasking

Medical terminology

ICD-10/CPT codes

Read clinical notes

Interdepartmental collaboration

Education

High school diploma or equivalent

Job description

Willapa Harbor Hospital in South Bend, WA is seeking a dedicated Insurance Authorization Specialist to manage organization-wide prior authorizations and coordinate referrals for medical procedures and services.

Responsibilities include verifying coverage, interpreting medical necessity guidelines, submitting clinical documentation to payers, maintaining accurate EHR updates, and communicating with patients, providers, and insurers to ensure timely, coordinated care across departments.