Patient Authorization and Referral Representative

Job Location:

Willapa Harbor Hospital
- South Bend, WA 98586

Salary Range: $26.73 - $42.16 Hourly, Pay - $26.73 - $42.16/hr

Benefits
- Medical, Dental, Vision, 403b Retirement

Shift
- Monday
- Friday 8:00 AM - 4:30 PM

This position is responsible for managing organization-wide insurance prior authorizations and coordinating specialist referrals for medical procedures and services. The role works closely with insurance providers, patients, clinical staff, and healthcare teams to support timely, accurate, and coordinated patient care. Responsibilities include interpreting insurance requirements, medical necessity guidelines, benefits, policies, and procedures; verifying coverage; submitting required clinical documentation to payers; maintaining accurate electronic health record documentation;

and communicating effectively with patients and providers throughout the authorization and referral process.

• Verify patient insurance eligibility and benefits and determine whether authorization is required for specific services.
• Obtain, track, and manage prior authorizations (for imaging, procedures, specialists' and admissions)
• Examine medical records to compile necessary supporting docuemtnation for requests.
• Submit clinical documentation to insurance payers.
• Process and track outgoing referrals, ensuring all required documentation is sent to specialist and tracking outcomes.
• Maintain accurate EHR (electronic health record) updates. Document all progress in the referral.
• Document progress and follow through on referrals. ("closing the door")
• Maintain detailed records of all authorization requests, approvals, and denials for compliance and audit purposes.
• Communicate with patients, providers, and insurers.
• Work as a part of an integrated team comprised of Patient Access, Patient Accounts, providers, and patients.
• Act as a liaison between all parties involved.
• Notify healthcare providers and clinical staff of authorization approvals, denials, or required modifications.
• Additional duties as assigned.

• High school diploma or equivalent.
• Two years' experience with prior authorizations preferred.
• Strong knowledge of insurance processes (including Medicare, Medicaid, and commercial plans).
• Understanding of medical necessity guidelines.
• Good communication, organization and multitasking skills.
• Familiarity with IDC-10 and CPT codes.
• Ability to read and interpret clinical notes.
• Ability to work collaboratively across departments.