Prior Authorizations and Referral Management Representative

🕒 July 9

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $21 - $29 / hour

⏱ Part Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 45%

What it means: the chance that no one is really hiring for this job.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 1920

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

St. Charles Health System is a comprehensive healthcare provider that offers a wide range of healthcare services including cardiology, cancer care, primary care, and behavioral health across multiple locations such as hospitals, urgent care, and outpatient centers. They focus on creating a healthier community by providing personalized care through their MyChart portal, which allows patients to manage appointments, view medical records, and pay bills online. St. Charles Health System is committed to patient-centered care and community health initiatives, offering programs like financial assistance, veteran and military programs, and travel medicine clinics.

📋 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 by facilitating coordination of care • Coordinate scheduling with surgery, specialist, ancillary, internal, and external departments • Confirm and validate health plan coverage, benefits eligibility, and coverage; 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 • Request and coordinate prior authorizations and referrals using internal and external systems • Facilitate patient scheduling with departments, clinics, and hospitals • Update systems with accurate prior authorization and referral information • Track, update, and investigate orders and tasks through completion • Monitor referral, authorization, and patient work queues; route orders for scheduling and completion • Obtain required documentation from providers, facilities, and patients • Communicate with providers, care team members, and patients about authorizations, scheduling, benefits, and eligibility • Assist with patient education and follow-up regarding authorization and referral processes • 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 • Customer service skills, particularly in stressful personal interactions • 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 multi-task and work independently • Attention to detail • Basic, intermediate, and advanced math skills, including analysis, statistics, significant data, or number manipulation • Intermediate ability and experience with electronic medical records systems, MS Office, MS Teams, and Excel • Ability to wear required personal protective equipment • Ability to perform the stated physical requirements • No risk for exposure to blood-borne pathogens

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