Prior Authorizations and Referral Management Representative

🔥 1 hour ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $21 - $29 / hour

⏱ Part Time

🟢 Junior

🚫👨‍🎓 No degree required

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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

• Responsible for coordination of prior authorization and referral processes for patients being referred for services, testing, specialty care, diagnostic procedures, and surgery. • Acts as a liaison between patients and the professional staff by facilitating coordination of care responsibilities. • Engages providers, care team, and patients in the prior authorization process. • Confirms and validates patient health plan coverage and obtains accurate benefit eligibility and coverage. • Communicates appropriate provider, facility, and order information to health plan as part of the prior authorization and referral process. • Notifies health plan and gains financial clearance for plans for patient to undergo a course of care requiring prior authorization. • Coordinates and supports providers with medication authorizations and may coordinate patient assistance programs. • Utilizes internal and external systems to appropriately request and coordinate prior authorization and referrals for patient care. • Facilitates the scheduling of patients with internal and external departments, clinics, and hospitals. • Tracks, updates, and investigates current orders and tasks; managing orders through the system to provide up-to-date and accurate information.

🎯 Requirements

• High School diploma or GED. • Minimum of one year experience working in hospital, clinic, or medical insurance billing office, performing duties and responsibilities related to medical billing, pre-authorization, claims processing, or a related area of expertise. • Basic understanding of medical coding. • Excellent communication and organizational skills with ability to interact with a diverse population and professionally represent St. Charles Health System with internal and external customers. • Excellent organizational skills, written and oral communication and customer service skills, particularly in dealing with stressful personal interactions. • Must adapt quickly to frequent process changes and improvements. • Is reliable, engaged, and provides feedback to inform process improvement. • Requires exceptional critical thinking and analytical skills with the ability to work under minimal supervision. • Requires 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 multi-task and work independently. • Attention to detail is essential. • Performs basic math (add, subtract, multiply and divide) calculations. • Performs intermediate to advanced math (analysis, statistics, significant data, or number manipulation). • Intermediate ability and experience in computer applications, specifically electronic medical records system, MS Office, MS Teams, and Excel.