Prior Authorization Representative

Financial Clearance Clerk

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 in Prior Authorizations

Preferred

• 1 year of relevant experience Revenue Cycle
• Epic Experience
• Payor Portal Experience
• Basic understanding of medical terminology

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.