Referral/Pre-Authorization Specialist
Remote | Full-Time (1.0 FTE) | Day Shift (8:30 AM to 5 PM)
Location: Remote (Oregon, Washington, or Alaska residents only; must live and work within one hour of a PeaceHealth hospital campus)
Pay Range: $24.32 - $32.84 per hour
The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.
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.
Why PeaceHealth? Why Now?
- Your work directly impacts patient access. You'll help remove barriers that stand between patients and the care they need.
- Remote flexibility with local connection. Work from home while remaining connected to a mission-driven healthcare system serving communities across Oregon, Washington, and Alaska.
- Be the expert others rely on. Providers, clinics, patients, and insurance carriers depend on your knowledge to keep care moving forward.
- Join a stable, respected not-for-profit health system. PeaceHealth has served Northwest communities for more than a century and continues to invest in both patients and caregivers.
- Build a long-term career. Grow your healthcare knowledge, strengthen your insurance expertise, and take advantage of education and development opportunities supported by PeaceHealth.
What You'll Do
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.
What You'll Enjoy About This Role
- A high level of ownership and autonomy in your daily work.
- Meaningful interactions with patients and care teams.
- Problem-solving that keeps healthcare moving forward.
- A balance of independent work and collaboration.
- The opportunity to become a trusted resource in a specialized area of healthcare operations.
What You'll Bring
Required Experience
- 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.
Preferred Education
- Coursework in business, healthcare administration, or a related field.
- Associate degree or two years of college coursework preferred.
Preferred Credentials
- Medical Assistant (MA)
- Licensed Practical Nurse (LPN)
- Registered Nurse (RN)
Skills for Success
- 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.
Life at PeaceHealth
At PeaceHealth, our mission is simple: to improve the health and wellbeing of the communities we serve. We believe exceptional patient care starts with supporting the people who make it possible.
We're committed to creating a workplace where every caregiver feels respected, valued, included, and empowered to contribute. We welcome individuals from all backgrounds and experiences and believe diverse perspectives make us stronger.
Benefits That Support You
PeaceHealth offers a comprehensive benefits package designed to care for your physical, emotional, financial, social, and spiritual wellbeing, including:
- 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
Location Requirement: This remote position requires residence and work location in Oregon, Washington, or Alaska, and candidates must live within a one-hour drive of a PeaceHealth hospital campus.
If you're passionate about helping patients access the care they need and want to use your insurance expertise in a role with purpose, we'd love to hear from you.
See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.
Requires 2+ years of healthcare insurance experience, referral or prior authorization experience, knowledge of insurance requirements and medical necessity documentation, strong communication, organization, and EMR skills.
Key Responsibilities
- reviewing referrals
- securing authorizations
- coordinating care
Skills & Tools
Electronic Medical Records (EMR), Microsoft Office
Job Details
- Category: Healthcare Services - Allied Health
- Seniority: Entry Level
- Commitment: Full Time
- Workplace: Remote — Vancouver or Oregon or Washington or Alaska
- Salary: USD 50,585 – 68,307 / year
- Languages: English
Benefits
- 401k matching
- Generous paid time off
- Tuition reimbursement
- Retirement plan
About PeaceHealth
A not-for-profit health system serving communities across the Pacific Northwest. — Industry: Healthcare