Corewell Health operates over 300 outpatient clinics across Michigan, bringing a multitude of care options to the communities that we serve. There are over 40 different types of primary care and specialty practices, which allows those who work in these clinics the opportunity to learn and explore various interests or to specialize in one area.
Prior Authorization Representative
Location
United States
Posted
5 days ago
Salary
Not specified
No structured requirement data.
Job Description
Job Summary
Provides clerical support to assist in the delivery of quality healthcare services via a Financial Clearance model by way of obtaining accurate and timely authorizations. Staff will be trained in various clinical service lines with the ability to support multiple areas within the Central Authorization team. Crucial to obtaining an authorization is the ability to read and understand basic insurance information as well as perform a complete and accurate registration. Training will consist of six weeks of in-person instruction and will shift to remote training after that time pursuant on satisfactory progress including authorizations obtained daily and a passing audit score.
Essential Functions
Demonstrates the ability to utilize all payer websites and maintains up to date credentials to assist verifying patient’s coordination of benefits and authorization requirements.
Able to perform chart abstraction to pull clinical data from a patient’s chart for review by a payer’s clinical team.
Adheres to all department procedures, guidelines, and standard work with the ability to utilize resources appropriately.
Complete authorization requests in a timely and efficient manor without compromising quality to ensure patients receive their care as scheduled.
Communicates barriers effectively to avoid patient delays in care demonstrating critical thinking skills to anticipate and resolve barriers to success.
Maintains a 95% or higher audit score consistently and be open to constructive feedback
Proficient in two clinical service areas navigating the nuances of those area’s authorization requirements.
Able to obtain 20 authorizations daily (consideration for type of service line).
Qualifications
Required
· High School Diploma or equivalent
· 1 year of relevant experience in related field
· 1 year of relevant experience Prior Authorizations Experience
Preferred
· Basic understanding of medical terminology
· Payor Portal Experience
· Epic Experience
· 1 year of relevant experience Revenue Cycle
About Corewell Health
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Kentwood Medical Office Building - 4600 Breton Rd SE - KentwoodDepartment Name
Contact Center Pre Authorizations - CorporateEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8 a.m. to 4:30 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
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