Prior Authorization Rep, Senior

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. Seniors are our team's subject matter experts and are responsible for new hire onboarding and act as the first resource utilized by staff when encountering issues.

Essential Functions

• Proficient in three clinical service areas navigating the nuances of those area’s authorization requirements.
• 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.
• Communicates barriers effectively to avoid patient delays in care demonstrating critical thinking skills to anticipate and resolve barriers to success. Additionally, a senior is expected to provide a recommendation(s) on how to resolve those barriers
• Works in conjunction with senior peers as well as department leads maintaining a healthy work relationship.
• Expected to perform monthly audits on staff in their respective clinical service lines and to address workflow concerns accordingly.
• Training new hires though our established onboarding process.

Qualifications

Required

• High School Diploma or equivalent
• 2 years of relevant experience Prior Authorization experience
• 5 years of relevant experience in related field.
• 1 year of relevant experience Revenue Cycle

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 SE - Kentwood

Department Name

Contact Center Pre Authorizations - Corporate

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:30 a.m. - 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 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.

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