Practice Prior Auth and Referral Specialist - Sleep Medicine

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. Position will include contacting patients with test results, triaging phone calls, entering orders, scheduling appointments. The Practice Prior Authorization and Referral Specialist is responsible for the coordination of prior-authorizations and referral process for patients being referred for specialty care, medications, and diagnostic procedures. Performs insurance verification, obtaining pre-authorizations, scheduling, and referrals. The specialist will secure the necessary prior authorization, then notify the patient aiding in the coordination of patient care.

JOB DUTIES AND RESPONSIBILITIES

Receive request for patient requiring specialty care through the electronic health record (EHR), direct order by provider communication, phone, and/or fax. Ensure patient demographic as well as insurance information are most accurate. Reviews patient insurance information and eligibility / verification to obtain prior authorization for specialty care and/or services. Obtain prior authorization from insurance companies prior to services being ordered and/or rendered. Documents in EHR prior authorization approval to ensure proper reimbursement. Works in collaboration with other supporting services / entities, central scheduling, and pre-encounters department. Responds to written as well as telephone inquires from patients, insurances, pharmacies, other outpatient/inpatient departments, and facilities regarding planned specialty care and/or services. Review and follow up on authorization and/or claim denials. Notify ordering provider of a prior authorization denials and if peer to peer need to be scheduled. Other duties as assigned.

PHYSICAL AND SENSORY REQUIREMENTS

Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephone, data entry, etc. Occasional twisting and turning. Uses upper extremities to life and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve needed materials. Hearing as it relates to normal conversation. Seeing as it relates to general vision.

EDUCATION

High school diploma or equivalent required. Prior authorization experience preferred.

TRAINING AND EXPERIENCE

One to two years of experience in medical billing, a medical office or insurances preferred. Working knowledge of medical office procedures as well as detailed understanding of ICD 10 and CPT codes. Knowledge of regulatory standards and compliance requirements. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer. Founded in 1872, St. Luke's University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 23,000 employees providing services at 16 campuses and 350+ outpatient sites. With annual net revenue in excess of $4 billion, the Network's service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke's hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke's Children's Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare's five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World's Best Hospital. The Network's flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Premier 13 times total and eleven years in a row, including in 2023 when it was identified as THE #4 TEACHING

HOSPITAL IN THE COUNTRY.

In 2021, St. Luke's was identified as one of the 15 Top Health Systems nationally. St. Luke's is the ONLY health care institution in the Lehigh Valley to be named a Top Workplace regionally repeating the exclusive honor for the third year in a row. Also, for the third straight year, St. Luke's has been a Top Workplaces in the Philadelphia Region by the Philadelphia Inquirer, ranking 9th in the large employer category for 2025 and the only health care system in PA to receive this award. In 2025, St. Luke's was recognized as a national Top Workplaces by USA Today, three years in a row, including the 3rd best health care system in the nation in 2023 and 2024. Lastly, in 2025, St. Luke's was named a Top Workplace in New Jersey for the third year in a row. Learn More Here.