Manager Cvs Prior Authorization Jobs in Oregon (NOW HIRING)

Referral Clerk

Evergreen Family Medicine is committed to providing excellent care for your family with clinics in Roseburg, Sutherlin and Myrtle Creek Oregon. Evergreen Family Medicine serves outpatient needs, including Urgent Care, Family Practice, Women's Health, Occupational Health, and school-based telehealth.

Evergreen Family Medicine is a Drug Free Workplace. All candidates that are offered employment will be required to pass a pre-employment drug screen and background check.

Responsibilities and Duties:

• Maintains confidentiality according to HIPPA regulations and EFM policies.
• Adheres strictly to EFM departmental standards and policies, including state and federal regulations.
• Communicates effectively and professionally with coworkers, managers and patients via phone, email or in person.
• Receives and coordinates all referrals and prior authorization requests, submitting appropriate information in a timely manner.
• Maintain current knowledge of all insurances including verifying benefits and eligibility for OHP, DCIPA & Atrio including PCP assignment.
• Advocates for patients by creating appropriate patient cases, requests, communications and appointments in Athena, on paper and in person.
• Maintains current working knowledge of medications, procedure and diagnosis codes with the ability to ascertain medical necessity requirements.
• Communication with outside provider offices, facilities and insurances via phone, fax and computer.
• Keeps an active working knowledge of Athena, engages in continuing education and trainings as offered by manager or company.
• Self Manages to stay on task, maximizes efficiencies and does not distract others as well as encourages others to do the same.
• Maintains a positive attitude, does not take work issues personally and does not allow personal issues to affect the work day.
• Ensures on a daily basis to promote an environment filled with teamwork, a positive outlook and constant professionalism.

• All other duties as assigned by manager.

Qualifications and Skills:

• High school diploma or equivalent required; additional medical office or healthcare administration training preferred.

• Minimum 1-2 years of experience in a medical office, referral coordination, prior authorizations, or related healthcare setting.

• Working knowledge of medical terminology, medications, and common procedure/diagnosis codes (ICD-10, CPT).

• Familiarity with insurance plans including OHP, DCIPA, Atrio, Medicare, Medicaid, and commercial carriers.

• Experience verifying insurance benefits, eligibility, and PCP assignment.

• Proficiency with electronic health record systems; Athena experience highly preferred.

• Understanding of HIPAA regulations and ability to maintain strict patient confidentiality.

• Ability to meet productivity standards and manage multiple tasks in a fast-paced environment.

• Strong organizational skills with attention to detail and accuracy.

• Communication Skills:Communicates clearly, professionally, and respectfully through phone, email, and in-person interactions with patients, coworkers, managers, and external providers.

• Referral & Authorization Coordination:Ability to create, track, and manage referrals and prior authorizations with accuracy and timely submission of required documentation.

• Technical Proficiency:Comfortable navigating EHR systems, faxing platforms, insurance portals, and general computer applications.

• Problem-Solving:Uses sound judgment to assess medical necessity and determine appropriate next steps for patient care coordination.

• Teamwork:Promotes a positive, collaborative work environment and supports coworkers with professionalism and encouragement.

• Time Management:Works independently, stays on task, and maximizes efficiency without disrupting others.

• Professionalism & Attitude:Maintains a positive outlook, handles stressful situations appropriately, and does not allow personal issues to impact work performance.

• Adaptability:Willingness to engage in ongoing training, education, and process improvements.

• Customer Service:Advocates for patients by ensuring accurate documentation, communication, and follow-through in all cases.

Physical requirements:

• 
  Prolonged periods sitting at a desk and working on a computer.
• 
  The employee is frequently required to walk; use hands and fingers, handle, or feel; and reach forward with hands and arms.
• 
  The employee is occasionally required to sit and stoop, kneel, or crouch.
• Must be able to lift up to 35 pounds at times.

Our culture and values are every employee's responsibility: The needs of our patient come first S.P.I.R.I.T

• Stewardship
• Patient & Population Focused Health Care
• Integrity
• Respect
• Innovation
• Teamwork