Top 127 Prior authorization work from home Jobs in Oregon

Prior Authorizations and Referral Management Representative
St. Charles Health System —Bend, OR
- $21.86 - $29.52 an hour
- Part-time
- Medical office experience
- Basic math
- Mid-level
Clinical Pharmacist
Shields Health Solutions —Portland, OR
- $60.00 - $69.71 an hour
- Microsoft Excel
- Microsoft Outlook
- Patient monitoring
- Paid parental leave
- Paid holidays
Quick Apply
Elections Program Manager (Business Operations Manager 1)
Secretary of State —Salem, OR
- $7,216 - $11,720 a month
- Full-time
- Hybrid work
- Clean driving record
- Mid-level
- Driver's License
- Paid holidays
- Disability insurance
10d
County & Customer Support Manager (Business Operations Manager 1)
Secretary of State —Salem, OR
- $7,216 - $11,720 a month
- Full-time
- Hybrid work
- Clean driving record
- Mid-level
- Driver's License
- Paid holidays
- Disability insurance
10d
Rules Coordinator (Operations & Policy Analyst 1)
Secretary of State —Salem, OR
- $4,771 - $7,287 a month
- Full-time
- Remote
- Mid-level
- 3 years
- Finance
- Paid holidays
- Disability insurance
3d
Centralized Service Representative
St. Charles Health System —Bend, OR
- $22.30 - $30.11 an hour
- Full-time
- Basic math
- Mid-level
- Microsoft Office
- Work from home
Care Coordinator II - DME Coordinator
CareOregon —Portland, OR
- $28.81 - $35.22 an hour
- Full-time
- Hybrid work
- Microsoft Outlook
- Primary Care
- HIPAA
- Wellness program
- Paid jury duty
7d
Patient Care Coordinator
Optum —Eugene, OR
- $18 - $32 an hour
- 8 hour shift
- Microsoft Outlook
- OSHA
- Customer service
- AD&D insurance
- Employee stock purchase plan
4d
Public Affairs Specialist 3
Oregon Health Authority —Portland, OR
- $6,581 - $10,105 a month
- 8 hour shift
- Hybrid work
- Marketing
- 5 years
- US work authorization
- Paid holidays
- Disability insurance
3d
Care Management Discharge Coordinator
Hillsboro Medical Center —Hillsboro, OR
- $27.45 - $38.69 an hour
- 8 hour shift
- Bilingual
- Hospital
- Word processing
3d
BMPS Data Analyst
AllCare Health —Grants Pass, OR
- $37 - $40 an hour
- Full-time
- Bilingual
- Microsoft Access
- Microsoft Outlook
- Health insurance
- 401(k)
Quick Apply
6d
Care Manager-Temporary/Part-Time
Santiam Hospital & Clinics —Stayton, OR
- $33.00 - $76.99 an hour
- Temporary
- Master of Social Work
- RN License
- Hospital
- Paid holidays
- Disability insurance
Quick Apply
Care Coordinator 2
Oregon Health & Science University —Portland, OR
- $30.34 - $41.02 an hour
- Full-time
- Hybrid work
- Bilingual
- Microsoft Excel
- Medical office experience
- Dental insurance
- Work from home
Resource Scheduler - Rehabilitation
The Portland Clinic —Portland, OR
- $19.46 - $26.35 an hour
- Full-time
- Physical & Rehabilitation Medicine
- Windows
- High school diploma or GED
- Health savings account
- AD&D insurance
7d
Veterans Suicide Prevention Coordinator-Program Analyst 3
Department of Veterans Affairs —Salem, OR
- $5,988 - $9,191 a month
- Full-time
- Hybrid work
- Mid-level
- Office
- Driver's License
- Paid holidays
- Health insurance
3h
Patient Care Coordinator
Providence —Seaside, OR
- $20.92 - $32.00 an hour
- Full-time
- Hospital
- Fair chance
- Entry level
- Paid parental leave
- Paid holidays
5d
Policy Analyst
Legislative Assembly —Oregon
- $6,136 - $9,201 a month
- Full-time
- Hybrid work
- Public speaking
- Mid-level
- Office
6d
Resource Scheduler - Foot & Ankle
The Portland Clinic —Portland, OR
- $19.46 - $26.35 an hour
- Full-time
- Windows
- High school diploma or GED
- Clinic
- Health savings account
- AD&D insurance
Ambulatory Care Clinical Coordinator / Pharmacist
CareOregon —Portland, OR
- $154,980 - $189,420 a year
- Full-time
- Customer service
- Word processing
- Outpatient experience
- Wellness program
- Paid jury duty
3d
Child Protective Services Worker (Social Service Specialist 1) Multiple Openings! 2 Locations!
Department of Human Services —Hermiston, OR
- $4,954 - $7,592 a month
- Overtime
- Background check
- Clean driving record
- Computer literacy
- Loan forgiveness

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prior authorization work from home jobs near oregon

Prior Authorizations and Referral Management Representative

St. Charles Health System -
Bend, OR

Apply Now

Job Details

Part-time
$21.86 - $29.52 an hour

Qualifications

Medical claims processing
Personal protective equipment (PPE) use
Phone communication
Medical coding
Medical office experience
High school diploma or GED
Insurance medical billing
Client interaction via phone calls

Full Job Description

Part Time, Days

Pay range: $21.86 - $29.52

ST. CHARLES HEALTH SYSTEM

JOB DESCRIPTION

TITLE: Prior Authorizations and Referral Management Representative

REPORTS TO POSITION: Applicable Ambulatory Access or Outpatient Clinic Leader

DEPARTMENT: Patient Access Services / St. Charles Clinic

DATE LAST REVIEWED: October 2024

OUR VISION: Creating America’s healthiest community, together

OUR MISSION: In the spirit of love and compassion, better health, better care, better value

OUR VALUES: Accountability, Caring and Teamwork

DEPARTMENTAL SUMMARY: Patient Access Services is a support services division of St Charles Health System. Patient Access serves as a liaison to inpatient and hospital-based outpatient departments. Ambulatory Access serves as a liaison to ambulatory outpatient departments by providing scheduling, registration, prior authorization, medical record, population health outreach, and project management support. We encourage collaboration between clinical and non-clinical staff to ensure we are providing our community with comprehensive and compassionate health care.

POSITION OVERVIEW: The Prior Authorizations and Referral Management Representative will be responsible for coordination of prior authorization and referral processes for patients being referred for services, testing, speciality care, diagnostic procedures, and surgery. This role acts as a liason between patients and the professional staff by facilitating coordination of care responsibilities. Extensive scheduling coordination with surgery department, specialist and ancillary departments. Prior Authorization and Referral Management Representatives’ home department may be a specific centralized location that is supported by Patient Access Services, or in a SCHS outpatient clinic supporting a single specialty.

This position does not supervise any other caregivers.

ESSENTIAL FUNCTIONS AND DUTIES

Must be able to multitask and prioritize workflows; engage providers, care team, and patients in the prior authorization process.

Confirms and validates patient health plan coverage and obtains accurate benefit eligibility and coverage. Makes appropriate system updates to coverage and benefits accurately.

Communicates appropriate provider, facility, and order information to health plan as part of the prior authorization and referral process.

Notifies health plan and gains financial clearance for plans for patient to undergo a course of care requiring prior authorization.

Coordinates and supports providers with medication authorizations. May coordinate patient assistance programs with patients and providers.

Utilizes internal and external systems to appropriately request and coordinate prior authorization and referrals for patient care.

Faciltates the scheduling of patients with internal and external departments, clinics and hospitals.

Updates and annotates systems with current and accurate information regarding requests for prior authorizations and referrals.

Tracks, updates and investigates current orders and tasks; managing orders through the system to provide up to date and accurate information.

Monitors system referral and authorization and patient work queues and lists to ensure each service or consultation order is managed, updated appropriately and accurately and routed for scheduling and completion.

Obtains pertinent documentation from provider, facility and patient to ensure accurate prior authorization and patient assistance requests.

Effectively communicate with provider, care team members and patients regarding authorizations, scheduling needs, insurance benefits, eligibility, etc.

Assist with patient education and follow up regarding the prior authorization and referral processes.

Oversees the facilitation of scheduling and appointments when referral is required on behalf of patient.

Ability to work as part of a Care Team with providers and clinical staff.

Supports the vision, mission and values of the organization in all respects.

Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.

Provides and maintains a safe environment for caregivers, patients and guests.

Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.

Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient and accurate.

May perform additional duties of similar complexity within the organization, as required or assigned.

EDUCATION

Required: High School diploma or GED.

Preferred: College level course work.

LICENSURE/CERTIFICATION/REGISTRATION

Required: N/A

Preferred: N/A

EXPERIENCE

Required: Minimum of one year experience working in hospital, clinic, or medical insurance billing office, performing duties and responsibilities related to medical billing, pre-authorization, claims processing, or a related area of expertise.

Basic understanding of medical coding.

Preferred: N/A

PERSONAL PROTECTIVE EQUIPMENT

Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

ADDITIONAL POSITION INFORMATION:

Must have excellent communication and organizational skills with ability to interact with a diverse population and professionally represent St. Charles Health System with internal and external customers.

Excellent organizational skills, written and oral communication and customer service skills, particularly in dealing with stressful personal interactions.

Must adapt quickly to frequent process changes and improvements.

Is reliable, engaged, and provides feedback to inform process improvement.

Attends all department, team, and company meetings as required.

Requires exceptional critical thinking and analytical skills with the ability to work under minimal supervision.

Requires strong communication, customer service, interpersonal skills and telephone etiquette.

Ability to prioritize workflow according to pre-set instructions.

Strong teamwork and collaborative skills.

Ability to multi-task and work independently.

Attention to detail is essential.

Performs basic math (add, subtract, multiply and divide) calculations.

Performs intermediate to advanced math (analysis, statistics, significant data, or number manipulation).

Intermediate ability and experience in computer applications, specifically electronic medical records system, MS Office, MS Teams, and Excel.

PHYSICAL REQUIREMENTS:

Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.

Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation.

Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing.

Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-15 pounds, operation of a motor vehicle.

Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level.

Exposure to Elemental Factors

Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface.

Blood-Borne Pathogen (BBP) Exposure Category

No Risk for Exposure to BBP

Schedule Weekly Hours:

Caregiver Type:

Regular

Shift:

First Shift (United States of America)

Is Exempt Position?

Job Family:

REPRESENTATIVE

Scheduled Days of the Week:

Monday-Friday

Shift Start & End Time:

Variable

Apply Now

Refine Your Search

prior authorization work from home jobs in oregon

Prior Authorizations and Referral Management Representative

Clinical Pharmacist

Elections Program Manager (Business Operations Manager 1)

County & Customer Support Manager (Business Operations Manager 1)

Rules Coordinator (Operations & Policy Analyst 1)

Centralized Service Representative

Care Coordinator II - DME Coordinator

Patient Care Coordinator

Public Affairs Specialist 3

Care Management Discharge Coordinator

BMPS Data Analyst

Care Manager-Temporary/Part-Time

Care Coordinator 2

Resource Scheduler - Rehabilitation

Veterans Suicide Prevention Coordinator-Program Analyst 3

Patient Care Coordinator

Policy Analyst

Resource Scheduler - Foot & Ankle

Ambulatory Care Clinical Coordinator / Pharmacist

Child Protective Services Worker (Social Service Specialist 1) Multiple Openings! 2 Locations!

I want to receive the latest job alert for prior authorization work from home in oregon

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