Lead Patient Access Representative

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. Leads oversee the processes of multiple clinical service lines and work closely with the Seniors representing those teams. Leads act as a second level of escalation for workflow concerns brought them by authorization staff including Seniors. An active component of the Lead role is tracking metrics and team performance to bring forward to Central Authorization leadership.

Essential Functions

• Leads are expected to effectively plan, prepare, and facilitate meetings with both an internal and external customer.

• Proficient in three clinical service areas navigating the nuances of those area’s authorization requirements.

• Works closely with Payer Relation’s representatives and TPA/Payer Reps to communicate barriers in workflows.

• Maintains a high level of chart abstraction to pull clinical data from a patient’s chart for review by a payer’s clinical team with the ability to coach others on technique.

• Adheres to all department procedures, guidelines, and standard work with the ability to utilize resources appropriately. Plays and active role in reviewing and authorizing standard work.

• Support their respective Supervisor in the rollout of new initiatives with the customer perspective in mind.

• Maintains a healthy relationship with all members of the Central Authorization team, working closely with their counterpart(s).

• Triages ERS’s and denials to root cause the source of the breakdown and recommend actionable change to Central Authorization leadership.

Qualifications

Required

• High School Diploma or equivalent.

• 5 years of relevant experience related field.

• 1 year of relevant experience revenue cycle experience required with experience in the senior role.

• 2 years of relevant experience Prior Authorization experience.

Preferred

• Basic understanding of medical terminology.

• Epic experience.

• Payor portal experience.

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 - Kentwood

Department Name

Pre-Authorizations

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:30 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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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 qualifie