Referral and Authorization Specialist

Full-time position, primarily Monday through Friday, 8 AM to 5 PM.

About the role

The Referral and Authorization Specialist processes all referrals from the assigned specialty area, securing pre-authorizations to facilitate timely appointments and support continuity of care within the health system.

Responsibilities

• Receive and transcribe all referrals in Asante’s referral tracking system.
• Assist with coordinating the scheduling of care based on clinical protocols.
• Send confirmation for scheduled services to the patient.
• Ensure patient demographic and insurance information accompanying the referral is accurate and complete; follow up with referring clinics and/or patients as needed to fill in missing or incorrect information.
• Obtain pre-authorizations and pre-certifications from third-party payers in accordance with payer requirements and document the authorization number and period of validity in the referral.
• Gather additional medical records from other providers as needed to support medical necessity when obtaining a preauthorization; follow up with payers on pre-authorization requests as needed.
• Identify patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage, along with Waivers for Oregon Health Plan and Commercial insurance patients.
• Accurately enter all referral information into appropriate systems daily to schedule the initial evaluation and follow-up appointments as needed.
• Ensure Therapists have all clinical information necessary for referral appointments and authorization forms; send any additional documents upon request.
• Alert the therapist involved in the patient’s care when there are issues with referrals or complications with insurance coverage.
• Inform the patient whether the authorization for the referral has been approved or denied, and discuss what other possible form of payment may be applicable.

Requirements

• Minimum of 2 years of healthcare-related insurance, scheduling, front desk, or comparable experience (required).
• Associate Degree in business or healthcare-related field (preferred).
• CHAA: Certified Healthcare Access Associate (preferred).

Pay

$20.53–$28.23 per hour, depending on experience.

Benefits

• Health & Wellness: Medical, dental, and vision coverage for part-time and above employees and their eligible dependents beginning within 30 days of hire.
• Retirement Savings: Employer-sponsored retirement plan with company contribution and match.
• Paid Time Off: Generous ETO for part-time and above employees.
• Professional Development: Tuition reimbursement and tuition repayment program.
• Additional Benefits: Life insurance, disability coverage, and employee assistance programs.