Prior Authorization & Referral Specialist

At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together.

Umpqua Health strongly encourages applications from candidates of color as well as veterans, aiming to foster a work environment that is linguistically and culturally diverse and inclusive. Please note that at this time, Umpqua Health does not offer visa sponsorship.

The Prior Authorization & Referral Specialist (PARS) ensures patients have been cleared for specialty service office visits, assisting the patient with pre-certification registration.  The PARS work as a liaison with the referring provider, patient and the specialist to relay case related concerns, insurance information and facilitate administrative components.

• Facilitates referrals and prior authorizations for all providers in the office.
• Provides accurate demographics and patient chart notes to referring offices.
• Provides patient with all necessary information regarding the specific referrals.
• Maintains a working knowledge of the Oregon Health Plan, Medicare and commercial insurance plans.
• Stays abreast of incoming patient documents, in the system, from providers and following HIPAA guidelines.
• Provide accurate and complete data input for preauthorization requests.
• Communicate with insurance companies, providers, pharmacies and patients regarding prior authorizations.
• Obtain all insurance authorizations and confirm appropriate authorizations have been received by the pharmacy, and/or insurance company.
• Responsible for completing daily self-audits to ensure accuracy of work.
• Be able to simultaneously enter data and complete benefit verification & authorizations.
• Accurately enter required information into the EMR.
• Attach incoming information to EMR and follow established procedures for distributing information for further review.
• Return telephone calls back to providers and pharmacies with preauthorization numbers as needed and file completed preauthorization requests as per established procedures.
• Alert supervisor to any issues or abnormalities encountered throughout the workday.
• Provides back-up support for the Front Office Staff, answers phones and books appointments.
• Check-in patients, verifying current demographics and insurance coverage. Notify back-office staff of patient’s arrival in a timely manner.
• Act as cashier in handling payments and co-payments.
• Contact the assistant or physician promptly if an acutely ill patient either telephones or approaches the reception desk with or without an appointment.
• Perform other duties and support deliverables as assigned by the organization to help drive our Vision, fulfill our Mission, and abide by our Organization’s Values.

• High School diploma or equivalent.
• 3 years healthcare experience, preferably in managed care.
• Prior authorization and referrals experience strongly preferred.
• Basic medical terminology preferred.
• EMR experience, ability to learn new systems and use technology.
• Possess time management and multitasking skills, able to thrive in a fast-paced environment.

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.