PSC Pre Auth Representative

JOB SUMMARY

Responsible for a wide range of duties in support of Patient Service Center (PSC) departmental efficiencies which may include but not limited to verification of benefits, obtaining authorization requirements, and authorization request submissions. Collaborates with PSC department leaders in operational and quality excellence. Demonstrates proficiency in the use of multiple electronic tools required by both Conifer and its clients.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Support clinical pre-authorization services team as follows:
  • Verify benefits and determine authorization requirements
  • Secure required authorizations for inpatient, outpatient and emergency services.
  • Address complex issues requiring clinical input and/or escalation (e.g. Peer to peer and/or denials)
• Builds and maintains collaborative relationships with both internal and external clients. Interact with clients and revenue cycle staff to facilitate the authorization process. Process includes but not limited to requesting clarification on orders, validating clinical documentation and follow up on pending requests.
• Support the effective operation of the organization’s quality management system through participation in quality control audit process, department projects and activities to improve overall scorecard metrics. Provides feedback regarding improvement opportunities for workflow and contributes to successful implementation.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Minimum typing skills of 35 wpm
• Demonstrated working knowledge of software/system/equipment
• Knowledge of function and relationships within a hospital / physician office environment preferred
• Advanced customer service skills and experience
• Ability to work in a fast-paced environment
• Ability to receive and express detailed information through oral and written communications
• Knowledge of Medical Terminology preferred
• Advanced understanding of third-party payer requirements preferred
• Advanced understanding of healthcare compliance standards preferred
• Ability to multi-task and manage time effectively

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• High School Diploma or GED required
• 2-4 years experience in medical facility, health insurance, or related area
• Some college coursework is preferred

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to sit at computer terminal for extended periods of time
• Occasionally lift/carry items weighing up to 25 lbs.
• Frequent prolonged sitting and walking

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.

OTHER

• Must be available to work hours and days as needed (including weekends and holidays) based on departmental/system demands
• Resolves and as applicable escalates Physician’s office and client issues
• May experience extreme case volumes and uncooperative parties

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.