Job Description
Authorization and Referral Specialist Valley Medical Center - 3.7 Maple Valley, WA Job Details Full-time $22.04 - $31.96 an hour 15 hours ago Qualifications Computer operation Patient scheduling systems Phone communication Practice management software Windows High school diploma or GED Desktop applications Typing Health information management Medical terminology Client interaction via phone calls
Full Job Description Job Title:
Authorization and Referral Specialist Req:
2026-0486 Location:
Department:
Lifestyle Medicine Maple Valley Shift:
Type:
Full Time FTE:
1 Hours:
City State:
Maple Valley, WA Salary Range:
Min $22.04 - Max $31.96/hrly DOE Job Description:
VALLEY MEDICAL CENTER JOB DESCRIPTION
The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization. TITLE:
Authorization and Referral Specialist JOB OVERVIEW
The Authorization and Referral Specialist is responsible for supporting the Lifestyle Medicine and Outpatient Rehabilitation service lines by providing treatment authorization, insurance verification, benefit summaries, scheduling, and referral management for all clinical services. Works closely with Patient Financial Services, Admitting Registrars, Providers, Insurance Companies and Patients to ensure a seamless coordination of services. DEPARTMENT
Lifestyle Medicine and Outpatient Rehabilitation WORK HOURS
Typically, Monday - Friday, 8:00 am to 5:00 pm or as needed to meet department needs. REPORTS TO
Lifestyle Medicine/Outpatient Rehabilitation Supervisor, Manager or Director PREREQUISITES
High School Graduate or equivalent (G.E.D.) required. Minimum three (3) years of experience in related medical and/or insurance industry required. Knowledge of medical terminology and abbreviations required. Basic skills in keyboarding and using a personal computer in Windows and Microsoft applications required. Prior experience in using practice management and electronic medical record systems required. Epic experience preferred. QUALIFICATIONS
Demonstrated knowledge of clinical ICD-10, CPT, and HCPCS. Professional written and verbal communication skills through all mediums. Ability to problem solve, exhibiting independent decision-making skills. Demonstrated ability to function independently and manage time. Demonstrated ability to access, analyze and apply concepts associated with protocol, policy, and guidelines. Excellent analytical, critical thinking and attention to detail skills. Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations. Demonstrated ability to successfully utilize varying computer tools and software packages: Utilize multiple monitors in facilitation of workflow management. Healthcare websites/Provider portals. Business practice management system. UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS
Requires legible writing and computer/keyboard skills. Excellent telephone skills are essential. Regular and punctual attendance is a condition of employment. Requires the ability to maintain self-composure and a positive attitude under stress. Requires flexible scheduling and extended hours as needed. Requires problem solving and effective resolution of conflicts. Requires the ability to organize and prioritize work, handling multiple demands simultaneously. Comfortable with continual change and can assimilate new information and use it as needed in daily operations. PERFORMANCE RESPONSIBILITIES
Generic Job Functions:
See Generic Job Description for Administrative Partner Essential Responsibilities and Competencies:
Effectively plan, direct, and manage high volume of treatments requiring referral management, scheduling, and prior authorization. Work as part of an integrated team comprised of Patient Access, Patient Financial Services, providers and admitting registrars. Collaborate with department leadership, clinical providers, and department staff to ensure safe, efficient, professional, and patient-centered care is provided. Apply clear understanding of the clinic structure, standards, procedures, and guidelines to ensure consistent and quality delivery of services. Maintains department specific records as assigned, update and verifies patient data in EMR. Referral Management and Scheduling Effectively organize and manage various referral work queues within the electronic medical record. Coordinate referrals to lifestyle medicine and outpatient rehabilitation services and collaborate with Admitting Registrars on scheduling. Maintain functional knowledge of patient access and services within the specialized field of Lifestyle Medicine and Outpatient Rehabilitation. Contact patients using both manual and automated systems to process incoming referrals, register and schedule for appointments. Insurance Verification and Authorization Contact insurance companies through portal use and phone contact to obtain benefit verification and prior authorization for treatment; including physical, occupational and speech therapy, cardiac and pulmonary rehab, nutrition and diabetes education and other integrated Lifestyle Medicine Programs. Organize, pre-authorize, and distribute pre-authorizations in a timely manner to all interested parties. Routinely review insurance policy updates/change to stay abreast of new ICD-10 and HCPCS pre-authorization requirements. Communicate with patients regarding insurance benefits, authorization, and billing process. Coordinate benefits for incoming patients and explore payment options so that our accounts are financially secure. Clear knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and Healthcare Common Procedure Coding System ( HCPCS) coding system. Resolve insurance denials and coordinate with billing to ensure proper coding and documentation is performed. Informs management team of pre-authorization requirement changes and potential barriers; maintains open line of communication to facilitate additional changes. Understands and follows formal chain-of-command guidelines in performing job duties. Projects and/or other duties as assigned. Created:
1/25 Revised:
3/25 Grade:
NC02 FLSA
NE Cost Center:
Multiple Job Qualifications:
PREREQUISITES
High School Graduate or equivalent (G.E.D.) required. Minimum three (3) years of experience in related medical and/or insurance industry required. Knowledge of medical terminology and abbreviations required. Basic skills in keyboarding and using a personal computer in Windows and Microsoft applications required. Prior experience in using practice management and electronic medical record systems required. Epic experience preferred. QUALIFICATIONS
Demonstrated knowledge of clinical ICD-10, CPT, and HCPCS. Professional written and verbal communication skills through all mediums. Ability to problem solve, exhibiting independent decision-making skills. Demonstrated ability to function independently and manage time. Demonstrated ability to access, analyze and apply concepts associated with protocol, policy, and guidelines. Excellent analytical, critical thinking and attention to detail skills. Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations. Demonstrated ability to successfully utilize varying computer tools and software packages: Utilize multiple monitors in facilitation of workflow management. Healthcare websites/Provider portals. Business practice management system.
