Referral​/Pre-Auth Specialist

Overview

Peace Health is seeking a Referral/Pre-Auth Specialist for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at Peace Health is $24.32 – $32.84. 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.

• 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.

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

• 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

• Preferred:
  Medical Assistant, LPN, or RN

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

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.

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.

Peace Health 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 Peace Health is committed to

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.