Referral and Prior Authorization Specialist

UnitedHealth Group•Corvallis, OR

1d•$18 - $32•Remote

About The Position

The Referral and Prior Authorization Specialist coordinates and facilitates internal and external authorizations for patients of The Corvallis Clinic. This remote position is based in Oregon and requires residence within commuting distance of the Corvallis office. The role is full-time, Monday through Friday, during normal business hours of 8:00 a.m. to 4:30 p.m. PST; occasional overtime may be needed. Up to four weeks of onsite training is provided at the Corvallis office on the same weekday schedule. The specialist reviews medical records and authorization requirements, obtains authorizations before scheduled procedures, submits supporting clinical documentation to insurance carriers, and records authorization details in patient charts. The role monitors requests, follows up with physicians, clinical staff, and insurers, communicates delays and authorization decisions, and supports resolution of denials, including appeals and claim resubmissions. The position also collaborates across departments and handles a high volume of work accurately and on time. Remote employees must maintain a dedicated, private work area, secure sensitive company documents, have approved high-speed internet service, and comply with UnitedHealth Group’s Telecommuter Policy. The salary range is $18–$32 per hour, based on full-time employment and factors such as local labor markets, education, work experience, and certifications. Benefits include a comprehensive benefits package, incentive and recognition programs, an equity stock purchase plan, and 401(k) contribution, subject to eligibility requirements. Candidates must pass a drug test before beginning employment.

Requirements

High school diploma/GED or equivalent years of work experience.
Must be at least 18 years old.
At least 1 year of experience working with medical prior authorizations.
At least 2 years of experience in a medical office.
At least 1 year of experience interacting with insurance companies.
At least 1 year of ICD-10 and CPT coding knowledge.
Computer proficiency, including Microsoft Outlook and Microsoft Teams, and ability to use multiple web applications.
Basic Microsoft Word proficiency, including creating, editing, and saving documents.
Basic Microsoft Excel proficiency, including creating, sorting, viewing, and filtering data.
Ability to be on camera for meetings during work hours.
Ability to work full-time Monday through Friday, 8:00 a.m.–4:30 p.m. PST, with occasional overtime if needed.
Ability to work remotely from within commuting distance of the Corvallis office.
Ability to keep company-sensitive documents secure, if applicable.
Ability to maintain a dedicated work area separated from other living areas that provides information privacy.
Must live in a location that can receive UnitedHealth Group-approved high-speed internet or have existing high-speed internet service.
Strong communication and customer service skills, in person and by phone.
Ability to work independently and demonstrate good judgment and accountability.
Ability to work well with others.
Strong organizational and time-management skills.
Ability to multitask and prioritize work to meet deadlines.
Ability to work under pressure in a fast-paced environment.
Excellent verbal and written communication skills, including speaking clearly and concisely, conveying information understandably, and understanding and interpreting information from others.
Must adhere to UnitedHealth Group’s Telecommuter Policy if working remotely.
Must pass a drug test before beginning employment.

Nice To Haves

Knowledge of anatomy and physiology.
Knowledge of medical terminology.

Responsibilities

Participate in and maintain a culture consistent with The Corvallis Clinic’s Service and Behavioral Standards Handbook.
Obtain authorizations for medical procedures before patients’ scheduled dates of service.
Process authorization requests and submit supporting clinical documentation to insurance carriers.
Document authorization information, including approval dates and authorization numbers, in patient charts.
Review medical documentation, records, diagnoses, and laboratory reports before requesting authorizations; check requests for accuracy and completeness and confirm that supporting documents are present.
Notify scheduling and clinical staff of delays in obtaining authorizations.
Ensure insurer documentation requirements are met and authorization documents are scanned and recorded in the patient’s medical record.
Review orders to determine whether testing requires authorization or is a covered benefit that does not require authorization.
Communicate with ordering physicians and clinical staff when required information is missing, and follow up with physicians, staff, and insurance companies as needed.
Monitor authorization requests to ensure timely processing and completion.
Communicate approvals and denials to ordering physicians and help resolve denials or other issues.
Review denials and submit appeals when requested by a physician to seek insurance approval.
Research, correct, and resubmit rejected and denied claims; prepare reconsiderations and coordinate with billing staff when a denial needs to proceed to appeal.
Inform the supervisor about changes or patterns identified while working procedure denials.
Collaborate with other departments to obtain pre-authorizations across functions.
Handle a high workload volume accurately and on time.
Perform other duties as assigned.