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 teams 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 areas authorization requirements.
• Demonstrates the ability to utilize all payer websites and maintains up to date credentials to assist verifying patients coordination of benefits and authorization requirements.
• Able to perform chart abstraction to pull clinical data from a patients chart for review by a payers 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

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CURRENT 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.