Specialist — Prior Authorization & Referrals

St. Luke’s University Health Network; Town of Easton (WI); On-site; USD 38,000 - 54,000; Full time

Job summary

St. Luke’s University Health Network in Wisconsin is seeking a Practice Prior Authorization and Referral Specialist to coordinate prior-authorizations and referrals for specialty care, medications, and diagnostics.

The role involves verifying insurance, obtaining pre-authorizations, scheduling, and communicating with patients, providers, and insurers to secure approvals and facilitate care.

Qualifications

• Minimum high school diploma or equivalent.
• 1–2 years experience in medical billing, a medical office, or insurance environments preferred.
• Knowledge of ICD-10 and CPT codes and general regulatory standards.

Responsibilities

• Receive requests for specialty care via EHR, provider orders, phone, or fax.
• Verify patient demographics and insurance information for accuracy.
• Review insurance eligibility to obtain prior authorization for specialty care and services.
• Obtain prior authorization from insurers prior to services being ordered or rendered.
• Document prior authorization in the EHR to ensure proper reimbursement.
• Collaborate with scheduling and pre-encounter teams and other departments.
• Respond to patient, insurer, pharmacy, and department inquiries about planned care.
• Follow up on authorization denials and schedule peer-to-peer reviews if needed.
• Perform other duties as assigned.

Skills

Medical billing

Insurance verification

Prior authorizations

Customer service

Education

High school diploma or equivalent

Job description

St. Luke’s University Health Network in Wisconsin is seeking a Practice Prior Authorization and Referral Specialist to coordinate prior-authorizations and referrals for specialty care, medications, and diagnostics.

The role involves verifying insurance, obtaining pre-authorizations, scheduling, and communicating with patients, providers, and insurers to secure approvals and facilitate care.