Specialty Prior Authorization & Referral Coordinator

St. Luke's University Health Network; Easton (Northampton County); On-site; USD 40,000 - 56,000; Full time

Job summary

St. Luke’s University Health Network is seeking an experienced Practice Prior Authorization and Referral Specialist to coordinate prior-authorizations and referrals for specialty care, medications, and diagnostic procedures.

The role requires accurate insurance verification, scheduling, and timely communication with patients and providers. Responsibilities include obtaining pre-authorizations, documenting approvals in the EHR, and following up on denials.

Qualifications

• High school diploma or equivalent required.
• Prior authorization experience preferred.

Responsibilities

• Coordinate prior-authorizations and referrals for specialty care, medications, and diagnostics.
• Verify patient demographics and insurance information for accuracy.
• Obtain prior authorization from insurers before services.
• Document approvals in the EHR to ensure proper reimbursement.
• Collaborate with scheduling and pre-encounters teams.
• Respond to inquiries from patients, insurers, pharmacies, and departments.
• Review denials and notify treating providers of outcomes.

Skills

Prior authorization

Insurance verification

Communication

Data entry

Scheduling

Education

High school diploma or equivalent

Tools

EHR software

ICD-10 coding

CPT coding

Job description

St. Luke’s University Health Network is seeking an experienced Practice Prior Authorization and Referral Specialist to coordinate prior-authorizations and referrals for specialty care, medications, and diagnostic procedures.

The role requires accurate insurance verification, scheduling, and timely communication with patients and providers. Responsibilities include obtaining pre-authorizations, documenting approvals in the EHR, and following up on denials.