Prior Authorization and Referral Specialist

1 week 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 Prior Authorization and Referral Specialist to join our team in the Sleep Medicine Office. As a key member of our team, you will be responsible for coordinating prior-authorizations and referral processes for patients requiring specialty care, medications, and diagnostic procedures.

Key Responsibilities
  • Receive and process requests for patient referrals through electronic health records, direct provider communication, phone, and/or fax.
  • Verify and update patient demographic and insurance information to ensure accuracy.
  • Review patient insurance information and eligibility to obtain prior authorization for specialty care and/or services.
  • Obtain prior authorization from insurance companies before services are ordered or rendered.
  • Document prior authorization approvals in electronic health records 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/or services.
  • Review and follow up on authorization and/or 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.
Physical and Sensory Requirements

Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephone, data entry, etc. Occasional twisting and turning. Uses upper extremities to lift and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve needed materials. Hearing as it relates to normal conversation. Seeing as it relates to general vision.



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