Referral/Pre-Auth Specialist Lead - Remote (WA & OR)

Job Description

Description

PeaceHealth is seeking a Referral/Pre-Auth Specialist Lead - Remote for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $20.65 – $30.97. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Must live in the states of Oregon or Washington!

Job Summary

Responsible for coordinating the day-to-day functions for assigned area. Assists with ensuring that departmental goals are achieved, timelines are met, and service excellence is provided in all aspects of work. Subject matter expert.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.

Essential Functions

• Assign work; plans and manages priorities; provides technical assistance; oversees staff schedules; monitors quality of work; monitors team projects; mentors staff; provides constructive feedback; oversees staff training; ensures quality improvement; provides leadership feedback on staff performance; and assists with goal setting for the team.
• 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

Education

• Accredited School Preferred: Business. or two years college in related field

Experience

• Minimum of 2 years Required: Working as referral/pre-authorization specialist or similar role.
• Required: Demonstrated experience in insurance requirements for referrals and/or prior authorizations to various therapies, surgeries, procedures, diagnostic testing, etc.
• Preferred: Previous leadership experience

Credentials

• Preferred : Medical Assistant, LPN, or RN

Skills

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

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.