Prior Authorizations and Referral Management Representative

🕒 July 28

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $21 - $29 / hour

⏱ Part Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 18%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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St. Charles Health System

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1918

🏥 Healthcare

📚 Education

Healthcare • Education

St. Charles Health System is a regional health care system based in Central Oregon that operates multiple hospitals and campuses (including Bend, Redmond, Prineville, and Madras). The organization provides acute and community health services—examples in the provided text include a family birthing center, EKG and other clinical care roles, workforce development (paid CNA training in partnership with a local community college), and a patient-centered culture emphasizing caregiver engagement and community ties. The system promotes recruitment and internal career mobility, offers employee benefits, and serves local communities in Central Oregon.

📋 Description

• Coordinate prior authorization and referral processes for patients referred for services, testing, specialty care, diagnostic procedures, and surgery • Act as a liaison between patients and professional staff to facilitate coordination of care • Coordinate scheduling with surgery, specialist, ancillary departments, clinics, hospitals, and external departments • Confirm and validate health plan coverage, benefits, and eligibility; update systems accurately • Communicate provider, facility, and order information to health plans • Obtain financial clearance for care requiring prior authorization • Coordinate medication authorizations and patient assistance programs • Use internal and external systems to request and coordinate prior authorizations and referrals • Update, annotate, track, and investigate orders, tasks, referrals, and authorizations • Monitor referral, authorization, and patient work queues to ensure orders are managed, routed, scheduled, and completed • Obtain required documentation from providers, facilities, and patients • Communicate with providers, care teams, and patients regarding authorizations, scheduling, insurance benefits, and eligibility • Assist with patient education and follow-up • Facilitate scheduling and appointments when referrals are required • Work as part of a Care Team with providers and clinical staff • Support organizational vision, mission, values, Lean continuous improvement, safety, confidentiality, compliance, and customer service standards • Attend required department, team, and company meetings • Perform additional duties of similar complexity as assigned

🎯 Requirements

• High School diploma or GED • Minimum of one year experience working in hospital, clinic, or medical insurance billing office, performing duties related to medical billing, pre-authorization, claims processing, or a related area • Basic understanding of medical coding • Excellent communication and organizational skills • Ability to interact with a diverse population and professionally represent St. Charles Health System • Ability to adapt quickly to frequent process changes and improvements • Exceptional critical thinking and analytical skills; ability to work under minimal supervision • Strong communication, customer service, interpersonal skills, and telephone etiquette • Ability to prioritize workflow according to pre-set instructions • Strong teamwork and collaborative skills • Ability to multitask and work independently • Attention to detail • Basic, intermediate, and advanced math capabilities as specified • Intermediate ability and experience with electronic medical records systems, MS Office, MS Teams, and Excel • Ability to wear required PPE