Practice Authorization and Referral Coordinator, Sleep Medicine Office

1 month ago


Fountain Hill, Pennsylvania, United States ST. LUKE'S UNIVERSITY HEALTH NETWORK Full time
Job Summary

St. Luke's University Health Network is seeking a skilled Practice Prior Authorization and Referral Specialist to join our team. This role is responsible for coordinating prior-authorizations and referral processes for patients requiring specialty care, medications, and diagnostic procedures.

Key Responsibilities
  • Verify patient demographic and insurance information to ensure accurate prior authorization requests.
  • Review patient insurance information and eligibility to obtain prior authorization for specialty care and services.
  • Obtain prior authorization from insurance companies before services are ordered or rendered.
  • Document prior authorization approvals in the electronic health record to ensure proper reimbursement.
  • Collaborate with other supporting services, central scheduling, and pre-encounters departments to ensure seamless patient care.
  • Respond to patient and insurance inquiries regarding planned specialty care and services.
  • Review and follow up on authorization and claim denials.
  • Notify ordering providers of prior authorization denials and schedule peer-to-peer discussions as needed.
Requirements
  • High school diploma or equivalent required.
  • Prior authorization experience preferred.
  • One to two years of experience in medical billing, a medical office, or insurance preferred.
  • Working knowledge of medical office procedures and detailed understanding of ICD-10 and CPT codes.
  • Knowledge of regulatory standards and compliance requirements.
What We Offer

St. Luke's University Health Network is an equal opportunity employer. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.


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