Prior Authorizations & Referrals Coordinator, High Lakes Upper Mill

Praxis Health•Bend, OR

7d•Onsite

About The Position

High Lakes Health Care, part of Praxis Health, is seeking a detail-oriented and organized Referral & Authorization Specialist to support our healthcare team by coordinating patient referrals and managing prior authorization requirements for medications, imaging, procedures, and specialty services. This role helps ensure patients receive timely access to appropriate care by working closely with healthcare providers, clinical staff, insurance companies, pharmacies, and outside facilities. The Referral & Authorization Specialist is responsible for reviewing orders and documentation, verifying insurance requirements, submitting authorization requests and referrals, tracking their progress, and maintaining accurate documentation throughout the process. The ideal candidate has healthcare experience, a strong understanding of insurance requirements and referral/authorization workflows, excellent attention to detail, and the ability to effectively manage a high-volume workload.

Requirements

High school diploma or equivalent required
2+ years of healthcare experience preferred, particularly in referrals, prior authorizations, medical billing, insurance verification, patient access, or a related healthcare setting.
Knowledge of health insurance plans, referral requirements, prior authorization processes, and payer guidelines preferred.
Experience working with electronic health record (EHR) systems, practice management systems, and insurance/payer portals.
Familiarity with medical terminology, diagnosis and procedure codes, clinical documentation, and healthcare workflows.
Experience communicating with insurance companies, healthcare providers, clinical teams, and outside medical facilities preferred.
Referral and prior authorization processing
Insurance verification and payer requirement interpretation
Understanding of healthcare documentation and medical terminology
Strong attention to detail and documentation accuracy
Excellent organizational and time-management skills
Strong written and verbal communication
Problem-solving and critical-thinking skills
Ability to prioritize and manage a high-volume workload
Ability to work independently while collaborating effectively with clinical and administrative teams
Ability to adapt to changing payer requirements, workflows, and departmental priorities
Commitment to patient confidentiality and HIPAA compliance

Nice To Haves

Associate’s or Bachelor’s degree in healthcare administration, health information management, medical assisting, or a related field preferred.

Responsibilities

Process and coordinate referrals and prior authorizations for specialty care, diagnostic imaging, procedures, medications, and other ordered healthcare services.
Review patient insurance coverage to determine referral requirements, prior authorization requirements, network restrictions, and other payer-specific guidelines.
Submit referrals and prior authorization requests through payer portals, electronic systems, phone, or fax as required.
Review orders and supporting clinical documentation for completeness and obtain additional information from clinical staff when necessary.
Gather and submit required documentation, including chart notes, diagnostic results, insurance information, and other supporting clinical records.
Communicate with providers, clinical staff, insurance representatives, pharmacies, and outside facilities to resolve referral or authorization issues.
Track pending referrals and authorizations and follow up with payers or receiving facilities as needed to support timely processing.
Review and document authorization approvals, denials, requests for additional information, and other payer determinations.
Assist with redirecting referrals or services when required due to insurance network restrictions, patient preference, or facility availability.
Maintain accurate and timely documentation of referral and authorization activities within the electronic health record (EHR) and/or practice management system.
Communicate authorization or referral status and requirements to appropriate clinical teams and staff.
Maintain knowledge of payer policies, referral requirements, authorization guidelines, and workflow changes.
Prioritize workload based on urgency, patient needs, payer requirements, and established departmental procedures.
Follow established department policies, procedures, and workflows to support consistent and efficient processing.