Referral/Pre-Auth Specialist - Remote (OR or WA)

at  PeaceHealth

Description
PeaceHealth is seeking a Referral/Pre-Auth Specialist - Remote for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $18.76 – $28.14. 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.

JOB SUMMARY

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.

EDUCATION

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

EXPERIENCE

• Minimum of 3 years Required: Experience working in insurance in a medical related field or other related experience.
• Required: Demonstrated experience in insurance requirements for referrals and/or prior authorizations to various therapies, surgeries, procedures, diagnostic testing, etc.

SKILLS

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

• 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.