Cvs Prior Authorization Remote Jobs in Oregon (NOW HIRING)

Job Title: Senior PCP Referral Expert

Classification: 1099 Contractor

Work Structure: Fully Remote

Hours/Schedule: Monday-Friday; 40-45 hours per week

Team: Clinical Operations

Reporting to: Senior Enrollment Operations Manager

Location: United States

Compensation: $30 per hour (no employment benefits e.g. health insurance, PTO are included) 

About Us:

One in three people die of heart disease - it's time to change that. We're redesigning heart health from the ground up so that everyone can live fuller lives. Our team consists of mission-driven clinicians, engineers, and professionals attacking a problem using evidence-based research and guidelines for cardiovascular rehabilitation. We're working to deliver exercise and wellness for the older adult cardiovascular disease using telemedicine. We are dedicated to delivering exceptional services that enhance the lives of our patients.

About the Role:

We are looking for a highly experienced Senior PCP Referral Expert to support the process of obtaining PCP referrals for patients enrolling in our virtual cardiac rehabilitation program.

This is a high-volume, execution-focused role requiring someone who is persistent, organized, resourceful, and highly experienced in navigating PCP offices and referral processes. You will follow up directly with PCP offices, track outstanding referral requests, troubleshoot common barriers, and help ensure required referrals are received and approved as quickly as possible.

The ideal candidate has 3+ years of direct experience obtaining PCP referrals, preferably within a high-volume healthcare environment, and is extremely comfortable navigating PCP offices, referral requirements, insurance processes, and common reasons referrals become delayed or unsuccessful.

While the primary focus of this role is PCP referral follow-up, the contractor may also assist with insurance benefits verification and prior authorization checks based on team and patient needs.

Scope of Services

• Work through a high-volume queue of patients requiring PCP referrals before beginning cardiac rehabilitation.
• Contact PCP offices via phone, fax, portal, and other approved channels to request and follow up on referrals.
• Conduct consistent and timely follow-up on outstanding referral requests.
• Confirm the status of requests directly with PCP offices rather than relying solely on fax or electronic submissions.
• Verify that received referrals contain the required information and documentation.
• Follow up with PCP offices when referrals are incomplete, incorrect, unsigned, or otherwise unable to be processed.
• Continue appropriate follow-up until a referral is received or a clear outcome is established.

• Investigate why individual referrals are delayed or unable to be completed.
• Navigate common PCP-office barriers, including missing requests, incorrect fax numbers, provider signature requirements, appointment requirements, incorrect referral information, and office-specific workflows.
• Identify when additional follow-up or escalation within a PCP office may be appropriate.
• Communicate with patients when their assistance is needed to facilitate the referral process.
• Identify situations where insurance requirements or other administrative barriers may be contributing to referral delays and escalate internally when appropriate.
• Clearly document unsuccessful referral outcomes and the reason the referral could not be obtained.
• Flag referrals that may not be completed before a patient's scheduled appointment.
• Follow established escalation pathways for referrals that remain unresolved.

As business needs arise, this role may also support insurance-related workflows, including:

• Completing insurance eligibility and benefits verification for patients.
• Confirming relevant coverage details, patient financial responsibility, and other benefit information needed before services begin.
• Determining whether prior authorization is required for services.
• Initiating or following up on prior authorization requests according to established workflows.
• Contacting insurance plans, provider offices, or other parties to obtain information needed to complete insurance or authorization checks.
• Accurately documenting insurance benefits and prior authorization outcomes.
• Escalating complex insurance or authorization issues according to established processes.

• Accurately document outreach attempts, conversations, referral statuses, barriers, and next steps.
• Maintain clear follow-up dates so outstanding referrals are consistently revisited.
• Ensure documentation is complete and easily understandable by other members of the team.
• Accurately categorize reasons referrals remain outstanding or are ultimately unsuccessful.
• Maintain accurate referral, insurance, and authorization statuses within designated systems and workflows.

What We're Looking For 

• 3+ years of direct experience obtaining and following up on PCP or physician referrals.
• Significant experience communicating directly with PCP offices, medical groups, and clinical staff.
• Strong understanding of healthcare referral workflows and documentation requirements.
• Demonstrated experience working through high-volume referral queues.
• Experience troubleshooting delayed, incomplete, rejected, or unsuccessful referrals.
• Exceptional persistence and follow-through, including comfort making repeated follow-up attempts when necessary.
• Strong phone communication skills and confidence navigating front-desk staff, referral coordinators, medical assistants, nurses, and other medical-office personnel.
• Excellent organization and documentation skills.
• Ability to efficiently work through and prioritize a large volume of outstanding referrals.
• Strong problem-solving skills and ability to investigate why a referral is not progressing.
• Comfort working in a fast-paced healthcare environment.

• Experience with Medicare Advantage and commercial insurance referral requirements.
• Experience completing insurance eligibility and benefits verification and/or prior authorization checks.
• Experience obtaining referrals for specialty care, cardiac care, rehabilitation, or other services requiring PCP referrals.
• Experience working with health plans, medical groups, IPAs, or delegated referral processes.
• Familiarity with payer portals, referral portals, EHRs, fax-based workflows, and insurance verification systems.
• Experience in centralized referrals, prior authorization, patient access, or revenue cycle operations.

We are looking for someone who is persistent, efficient, detail-oriented, and highly comfortable communicating with PCP offices and following up on outstanding requests.

You understand that getting a referral completed may require multiple calls, faxes, conversations, corrections, and follow-ups. You are comfortable navigating those steps, figuring out why a request is stuck, and continuing through the appropriate process until there is a clear outcome.

You are also adaptable and comfortable supporting adjacent workflows, such as insurance benefits verification and prior authorization checks, when additional support is needed.

Most importantly, you understand that administrative delays can prevent patients from beginning care, and you bring the urgency and attention to detail needed to help patients move forward.

*Note: This is a 1099 Contractor position only.