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Patient Authorization and Referral Representative
3 months ago
Description
The Patient Authorization and Referral Representative (PARR) is responsible for the implementation of policies and procedures relating to aspects of the Referral Operations department in Providence Medical Group (primary care and specialty clinics) and performs duties supporting the core functional areas of specialist referral processing, diagnostic authorizations, prior authorization, denials/appeals, and training. The work focuses on department support of activities such as: production, service level agreements, strategic outcomes, standards and objectives, and performance improvement activities relevant to Referrals Operations. The PARR assures an integrated approach to the program is fulfilled, resulting in timely scheduling of requested services, communication across the continuum of care for requested outpatient services, improvement in the provision of care and services, and improved satisfaction for our patients, providers, staff, and external contacts. The PARR functions in a team environment, providing requested services in a centralized setting on behalf of the medical group clinics.
This position serves as an expert resource to Providence Medical Group (PMG) and Clinical Program providers, specialists, and staff regarding the specialist referral /prior authorization requirements for multiple contracted and non-contracted insurance plans, diagnostic imaging protocols which vary between the multiple facilities/sites providing this service, and processes relating to these functions.
This position is the liaison between PMG and clinical program physicians, patients, multiple Providence Health System Diagnostic Imaging scheduling and modality (e.g., CT, MRI, Nuclear Medicine) departments, freestanding diagnostic imaging centers, hospital facilities and the contracted insurance plans. In addition to specialist referral processing, this position also facilitates prior authorization for selected procedures as directed by the patients' insurance.
Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Group and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
- H.S. Diploma or GED
- 2 years experience in Health Care Industry or related field
- Physician Office
- Revenue Cycle
- Physician or Hospital Billing
- Health Insurance
- Outpatient ambulatory
- Clinical Quality
- 2 years experience in a referral management functional area such as prior authorization, referrals, appeals, business office or insurance health plans.
Preferred Qualifications:
- Bachelor's Degree or the position requires a minimum of 2 years experience in an healthcare system. Experience in Professional Billing Revenue Cycle Management
- Epic software experience
- Experience in database management and spreadsheets
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
About the Team
Providence Physician Enterprise (PE) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.
PE is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington's greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence's St. John's Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Requsition ID: 289978
Company: Providence Jobs
Job Category: Patient Access
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Admin Support
Department: 5011 PMG N REFERRAL OPS
Address: OR Portland 4400 NE Halsey St
Work Location: Providence Office Park Portland Bldg 1-Portland
Pay Range: $19.80 - $30.24
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
