Patient Authorization and Referral Representative - Scheduling

Providence • Seattle, WA

1d

About The Position

The Prior Authorization Specialist facilitates processing of medication prior authorizations for clinic patients in accordance with established guidelines. This position serves as a liaison between physicians, pharmacies, clinic staff and insurance carriers to assure high quality service to Swedish patients and clinics. Providence caregivers are not simply valued – they’re invaluable. Join our team at Swedish Health Services DBA Swedish 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.

Requirements

• 2 years experience in a medical clinic or managed care/health insurance plan within the past 2 years

Nice To Haves

• Bachelor's degree in a related field
• 2 years experience in an area such as prior authorizations, medical audits, appeals or delegation
• 1 year Epic software experience

Responsibilities

• Demonstrates proficiency in the core functions of one or more medication prior authorization areas, including prior authorizations, appeals, audits, and training.
• Serves as a resource for the Prior Authorization Service by providing technical assistance to clinic staff and physicians regarding patient coverage, authorization guidelines and procedures, claims research, and departmental operating procedures.
• Utilizes and navigates various insurance company websites to obtain medication prior authorization requirements and protocols.
• Receives, triages, and responds appropriately to phone calls from pharmacies and clinics seeking assistance.
• Processes all documentation and forms related to medication prior authorizations, including submissions via fax, online portals, and telephone.
• Verifies member eligibility as necessary to process medication prior authorizations and collaborates with clinic staff and pharmacies to obtain required information.
• Reviews patient charts to gather documentation supporting the medical necessity of requested medications.
• Completes prior authorization requests by incorporating relevant clinical information and benefit details, including plan limitations and exclusions, to support the medical review process.
• Contacts clinics to obtain additional clinical information, such as chart notes and diagnostic results, as needed to facilitate the medical review process.

Benefits

• 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 improving the health and wellbeing of each patient we serve.
• Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits.
• Changes in benefits, including paid time-off, happen for various reasons.
• These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level