Prior Authorization & Referral Specialist - Patient Access

St. Charles Health System Inc.; Bend (OR); Hybrid; USD 46,000 - 63,000; Full time

Job summary

St. Charles Health System in Bend, Oregon seeks a Prior Authorizations and Referral Management Representative. This full-time role coordinates prior authorizations and referrals for services, tests, and surgeries, acting as a liaison between patients and providers to streamline care.

Requires at least one year in hospital/clinic billing and a basic understanding of medical coding. Strong communication, organization, and teamwork are essential for success in this position, with comprehensive

Qualifications

• Minimum of one year experience in hospital, clinic, or medical insurance billing office.
• Basic understanding of medical coding.
• Excellent communication and organizational skills with ability to interact with a diverse population.

Responsibilities

• Coordinate prior authorization and referral processes for services, tests, and surgeries.
• Validate patient health plan coverage and obtain benefit eligibility.
• Communicate provider, facility, and order information to health plans.
• Schedule and coordinate with surgery, specialists, and ancillary departments.
• Maintain accurate documentation in EMR and related systems.

Skills

Medical billing understanding

Medical coding basics

Interpersonal skills

MS Office

Education

High School diploma or GED

College level coursework

Tools

Electronic medical records system

MS Office

Excel

Job description

St. Charles Health System in Bend, Oregon seeks a Prior Authorizations and Referral Management Representative. This full-time role coordinates prior authorizations and referrals for services, tests, and surgeries, acting as a liaison between patients and providers to streamline care.

Requires at least one year in hospital/clinic billing and a basic understanding of medical coding. Strong communication, organization, and teamwork are essential for success in this position, with comprehensive