PeaceHealth Referral/Pre-Authorization Specialist - PFS Referrals & Eligibility PHMG in Vancouver, Washington

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

Req ID: 168347

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:

  • 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.

SHARED SERVICES PHYSICAL/COGNITIVE REQUIREMENTS:

  • Work requires fairly light physical exertion up to 65% of the time.

  • Ability to lift objects weighing 30 lbs. or less.

  • Work is performed under normal working conditions with adequate lighting and ventilation.

  • Job duties frequently require intense concentration and attention to detail (34-65% of work time).

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, Wash., 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 900 providers and 10 medical centers serving both urban and rural communities throughout the Northwest. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission.

We offer competitive compensation, a robust benefits package at http://www.peacehealth.org/sites/default/files/externalallbenefits_overview.pdf and a collaborative, Mission-driven work environment! To learn more about working at PeaceHealth and the Vancouver 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 at https://www.facebook.com/PeaceHealthCareers or LinkedIn at http://www.linkedin.com/company/peacehealth !

Questions? Review our Employment FAQ at https://www.peacehealth.org/sites/default/files/externalcandidatefaq2.pdf or email Recruitment@peacehealth.org . Please note this email does not accept resumes or applications.

Location: Vancouver, Shared Services Center (802)

Job Category: Business, Administrative & Facilities

Shift: Day

Shift Length: 8 Hours

FTE: 1.0

Work Type: Full Time

Hourly compensation starts at: $16.59, 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 || Business, Administrative & Facilities || Other - Administrative || Full Time || PATIENT ACCOUNTING