PeaceHealth is seeking a Referral/Pre-Auth Specialist for a Full Time, 1.00 FTE, Day position.
Must be fully vaccinated for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date.
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.
- 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.
- 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.
- Proficient computer skills including MS Office applications.
- Good communication skills, both verbal and written.
SHARED SERVICES PHYSICAL/COGNITIVE REQUIREMENTS:
- Work requires fairly light physical exertion 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 (34-65% 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.