Referral & Authorization Specialist — Patient Access Expert

Praxis Health; Bend (OR); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Medical, Dental, Vision with network/8

401(k) with employer match

Paid Time Off

Free in-house diagnostic testing

Job summary

High Lakes Health Care, part of Praxis Health, seeks a detail-oriented Referral & Authorization Specialist to coordinate patient referrals and manage prior authorizations for medications, imaging, procedures, and specialty services.

You will work with providers, clinical staff, insurance companies, pharmacies, and outside facilities to ensure timely access to care, review orders for completeness, and maintain accurate documentation in the EHR and practice management systems.

Qualifications

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, health information management, medical assisting, or a related field preferred.
• 2+ years of healthcare experience preferred, particularly in referrals, prior authorizations, medical billing, insurance verification, patient access, or a related healthcare setting.
• Knowledge of health insurance plans, referral requirements, prior authorization processes, and payer guidelines preferred.

Responsibilities

• Process and coordinate referrals and prior authorizations for specialty care, diagnostic imaging, procedures, medications, and other ordered healthcare services.
• Review patient insurance coverage to determine referral requirements, prior authorization requirements, network restrictions, and other payer-specific guidelines.
• Submit referrals and prior authorization requests through payer portals, electronic systems, phone, or fax as required.
• Review orders and supporting clinical documentation for completeness and obtain additional information from clinical staff when necessary.
• Gather and submit required documentation, including chart notes, diagnostic results, insurance information, and other supporting clinical records.
• Communicate with providers, clinical staff, insurance representatives, pharmacies, and outside facilities to resolve referral or authorization issues.
• Track pending referrals and authorizations and follow up with payers or receiving facilities as needed to support timely processing.
• Review and document authorization approvals, denials, requests for additional information, and other payer determinations.

Skills

Referral processing

Prior authorization processing

Insurance verification

Payer guideline interpretation

Documentation accuracy

Time management

Written and verbal communication

HIPAA compliance

Independent and collaborative work

Problem solving

Education

High school diploma or equivalent

Associate/Bachelor in healthcare administration or related field

Tools

EHR systems

Practice management systems

Insurance/payer portals

Job description

High Lakes Health Care, part of Praxis Health, seeks a detail-oriented Referral & Authorization Specialist to coordinate patient referrals and manage prior authorizations for medications, imaging, procedures, and specialty services.

You will work with providers, clinical staff, insurance companies, pharmacies, and outside facilities to ensure timely access to care, review orders for completeness, and maintain accurate documentation in the EHR and practice management systems.