Experience:
1-3 years of experience
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Employment Type:
Full time
Posted:
6/2/2017
Job Category:
Health Care Provider
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Referral/Pre-Authorization Specialist - Medical Group Referrals & Eligibility Job
PeaceHealth | Vancouver, Washington
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Job Description

Req ID: 146227

PeaceHealth is seeking a Referral/Pre-Authorization Specialist - Medical Group Referrals & Eligibility for a 1.0 full time equivalent Non-Exempt position. This position will be working Day shift with shift durations of 8 Hours.

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.

ESSENTIAL FUNCTIONS

1. 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.

2. 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.

3. Works in collaboration with Patient Financial Services to improve the Revenue Cycle process.  Continually improve work process to enhance service and customer relations.

4. 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.

5. Performs other duties as assigned.

QUALIFICATIONS

EDUCATION:

  • High school diploma or equivalent required.
  • Two years college in related field or accredited business school preferred.
  • Medical Assistant, LPN, or RN highly desired.

EXPERIENCE/TRAINING:              

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

OTHER SKILLS:  

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

Please apply online to be considered. For full consideration of your skills and abilities, please attach a current resume with your application.

About PeaceHealth

PeaceHealth, based in Vancouver, WA, is a not-for-profit Catholic health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 16,000 caregivers, a multi-specialty medical group practice with more than 800 physicians and providers, a comprehensive laboratory system, and ten medical centers serving both urban and rural communities throughout the Northwest. In 1890, Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues to serve communities when invited to do so with a spirit of collaboration and stewardship – the spirit of health.

We offer competitive compensation, a robust benefits package and a collaborative, Mission-driven work environment! To learn more about working at PeaceHealth and the Vancouver, WA community please visit our homepage: www.peacehealth.org/careers.

Get a feeling for the Spirit of PeaceHealth through this three-minute video, and visit us on Facebook or LinkedIn!

Questions? Review our Employment FAQ or email Recruitment@peacehealth.org. Please note this email does not accept resumes or applications.

Location: Vancouver, WA, Shared Services Center (802)
Job Category:  Administrative; Professionals - Other
Shift:  Day
Shift Length: 8 Hours
FTE: 1.0
Work Type:  Full Time
Hourly compensation starts at: $15.08, more depending on experience
Required Certifications/Licensure: 

PeaceHealth is committed to providing equal employment opportunities to all qualified job applicants and employees without regard to the following statuses: protected veteran; qualified individual with a disability; race; ethnicity; religion; gender; pregnancy; gender identity; national origin; age; genetic information; sexual orientation; or any other protected status in accordance with local, state, or federal laws.

The above information is intended to indicate the general nature and level of work performed by this position. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job.

Posting Notes: Vancouver, WA || Administrative; Professionals - Other || Full Time || PATIENT ACCOUNTING

About PeaceHealth

PeaceHealth is a not-for-profit health care system sponsored by the Sisters of St. Joseph of Peace, with services in Washington, Oregon and Alaska. PeaceHealth's rigorous pursuit of exceptional medicine springs from its mission, values, and commitment to provide healing and compassionate care to patients and families.

This company profile was created by AfterCollege and is about PeaceHealth. This page is not endorsed by or affiliated with PeaceHealth. For questions regarding company profiles, please email: care@aftercollege.com.