[Hiring] Referral/Pre-Auth Specialist @PeaceHealth

Role Description

Help patients get the care they need, without the delays they don't. Every referral approved and every authorization secured helps a patient move one step closer to treatment, testing, or a specialty appointment. If you're experienced with insurance requirements and enjoy solving complex healthcare puzzles while making a meaningful impact on patients' lives, this is an opportunity to do work that truly matters from the comfort of home.

In this role, you'll help patients navigate the insurance approval process so they can receive timely care. You will:

• Review referral and prior authorization requests from clinics and care teams.
• Submit authorization requests to insurance carriers and follow them through completion.
• Gather and verify clinical documentation needed for approvals.
• Communicate with patients about authorization status, next steps, and required information.
• Partner with physicians, specialists, clinics, and insurance companies to coordinate care.
• Document referral and authorization activity accurately in the medical record.
• Monitor authorization requirements and insurance guideline updates.
• Help resolve issues that could delay patient care or treatment.
• Work independently while collaborating closely with clinical and revenue cycle teams.
• Look for opportunities to improve processes and create a better patient experience.

Qualifications

• At least two years of experience working with insurance in a healthcare setting or related field.
• Experience obtaining referrals and/or prior authorizations for services such as:
  • Diagnostic testing
  • Procedures
  • Surgeries
  • Therapies
  • Specialty care services
• Knowledge of insurance requirements, medical necessity documentation, and authorization processes.

Requirements

• Coursework in business, healthcare administration, or a related field preferred.
• Associate degree or two years of college coursework preferred.
• Preferred Credentials:
  • Medical Assistant (MA)
  • Licensed Practical Nurse (LPN)
  • Registered Nurse (RN)
• Strong attention to detail and follow-through.
• Ability to manage multiple priorities and deadlines.
• Clear verbal and written communication skills.
• Comfort working with electronic medical records and Microsoft Office applications.
• Ability to navigate changing insurance requirements and resolve issues proactively.

Benefits

• Medical, dental, and vision coverage
• 403(b) retirement plan with employer contributions and matching opportunities
• Generous paid time off
• Employer-paid life and disability insurance
• Tuition reimbursement and continuing education support
• Wellness resources and programs
• Expanded Employee Assistance Program (EAP)
• Mental health and wellbeing support