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Referral/Pre-Auth Specialist Lead

Job ID: 4663
Location: Vancouver, WA
Work Type: Full Time
Shift: Day
Shift Length: 8 Hours
FTE: 1.00
Benefit Eligibility: Full-time benefits

Job Description

Description

PeaceHealth is seeking a Referral/Pre-Auth Specialist Lead for a Full Time, Day position.  Hourly compensation starts at $18.99, more depending on experience.

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

  1. 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.
  2. 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.
  3. 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.
  4. Works in collaboration with Patient Financial Services to improve the Revenue Cycle process. Continually improve work process to enhance service and customer relations.
  5. 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.
  6. Performs other duties as assigned.

QUALIFICATIONS

EDUCATION:

  • Two years college in related field or accredited business school preferred.
  • Medical Assistant, LPN, or RN highly desired.

EXPERIENCE/TRAINING:

  • Minimum of two years 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.
  • Previous leadership experience preferred.

LICENSE/CERTIFICATION:

  • N/A

OTHER SKILLS:

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

SYSTEM PHYSICAL/COGNITIVE REQUIREMENTS

  • Work requires fairly light physical exertion from up to 65% of the time.
  • Ability to lift objects weighing 30 lbs. or less.
  • Work is performed under normal working conditions with adequate lighting and ventilation.
  • Job duties frequently require intense concentration and attention to detail (up to 65% of work time).

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.  

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