Referral/Pre-Authorization Specialist - Remote

Job Description

Description

PeaceHealth is seeking a Referral/Pre-Authorization Specialist (Remote) for a Full Time, 1.00 FTE, Day position. The general salary range for this job opening at PeaceHealth is $18.30 – $27.46. The actual hiring rate is dependent upon several factors, including but not limited to, the job/position responsibilities, location, terms of the applicable collective bargaining agreement, education, training, work experience, seniority, work performance, etc.

*Must live in Oregon, Washington, Texas or Alaska.*

Responsible for receiving, processing and documenting referral or prior authorization requests from the clinical areas. Provides customer service and support for the clinical areas and patients for referrals and prior authorizations.

POSITION DETAILS:

• Oversees the data entry and completion of referral forms/notifications. Obtains insurance pre-authorization for patients and re-authorization of additional treatment. Ensures insurance carrier documentation requirements are met and referral support documentation is filed in patient’s medical record.
• Efficiently manages correspondence with patients, physicians, specialists, and insurance companies. Documents pertinent information on referral form and/or in medical record. Ensures practitioners are following standardized guidelines as recommended by evidenced based medicine.
• Works in collaboration with Patient Financial Services to improve the Revenue Cycle process. Continually improve work process to enhance service and customer relations.
• Works to improve Managed Care processes, communication, and patient care as it relates to Managed Care. Keeps up with continual changes in the health insurance Managed Care arena and communicates those changes as appropriate.
• Performs other duties as assigned.

WHAT YOU BRING:

• Two years college in related field or accredited business school preferred.
• Medical Assistant, LPN, or RN highly desired.
• Minimum of three years of experience working in insurance in a medical related field or other related experience.
• Demonstrated experience in insurance requirements for referrals and/or prior authorizations to various therapies, surgeries, procedures, diagnostic testing, etc.

OTHER SKILLS:

• Proficient computer skills including MS Office applications.
• Good communication skills, both verbal and written.

Department / Location Specific Notes

Home Infusion:

• Follow-up work with denials and appeals for Prior Authorizations.
• Efficient communication and correspondence with the Home Infusion team including the Manager/Supervisor, PCC, PAR, Pharmacist, Dietitian and Enteral Technician.

Working Conditions

Lifting

• Consistently operates computer and other office equipment.

• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

• Sedentary work.

Environmental Conditions

• Predominantly operates in an office environment.

Mental/Visual

• Ability to communicate and exchange accurate information.

• The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.

PeaceHealth requires a completed Primary Vaccine Series (e.g., 2 dose monovalent Pfizer, Moderna or Novavax series or 1 dose J&J vaccine series) or be Up to Date (receiving the most recent Pfizer/Moderna bivalent vaccine/booster) for COVID-19 vaccination prior to their start date. PeaceHealth has a medical and religious exemption request process for those that are unable to receive the COVID-19 primary vaccine series due to medical/religious reasons. For caregivers that will be working in Oregon there is a personal vaccine exemption form that may be requested.