Authorization Representative - Oncology

Tenet Healthcare • Commerce Charter Township, MI

3d

About The Position

Under general supervision, the Authorization Representative secures and tracks authorizations and referrals throughout a patient's stay or visit. The role ensures that authorizations, referrals, and re-authorizations are obtained for hospital and clinic patients and that required authorizations are received as part of the care and customer service process.

The representative verifies and updates insurance information in SMS registration pathways to support timely payment and clean claims, coordinates with eligibility vendors and Clinical Resource Management as needed, and obtains financial approvals and supporting documentation for internal financial assistance programs. The position also interprets managed care contracts and other third-party payer contacts to obtain the correct authorization or referral, updates the Dedicated Authorization log daily, and provides reports to management.

Requirements

• High school diploma or equivalent.
• Four or more years of prior work experience in patient registration or patient accounting, with knowledge of third-party payors.
• Familiarity with medical terminology and concepts.
• Working knowledge of third-party insurance verification, related systems, authorization and referral procedures, and the internal and external clinical care process.
• Comprehensive knowledge of the patient access process.
• Working knowledge of Michigan-based managed care programs.
• Ability to understand and apply third-party payor requirements, verification procedures, and insurance benefit knowledge.
• Strong customer service skills to work effectively with hospital staff, diverse populations, patients, internal staff, and external organizations, including when relaying sensitive and confidential information.
• Excellent verbal and interpersonal skills, including strong face-to-face communication.
• Ability to work as part of a team with clinical staff, the business office, and payer staff.
• Ability to manage multiple tasks and organize work appropriately.
• Analytical skills to calculate patient liability and income status and solve credit and collection problems.
• Communication and interpersonal skills to discuss and interpret technical information and departmental or functional policy with internal and external stakeholders; discretion, conflict resolution, diplomacy, tact, and listening skills are required.
• Ability to read and comprehend policies and interpret technical materials in the specialty area.
• Proficiency with computers, database programs, and a variety of spreadsheet programs.

Nice To Haves

• Associate degree in finance or business administration.

Responsibilities

• Secure and track authorizations and referrals through the patient's stay or visit.
• Obtain and secure authorizations, referrals, and re-authorizations for hospital and clinic patients.
• Ensure authorizations have been received as part of the patient care and customer service process.
• Verify and update insurance information in SMS registration pathways to support timely payment and clean claim requirements.
• Coordinate with outside eligibility vendors and Clinical Resource Management using established criteria.
• Obtain financial approvals and supporting documentation for internal financial assistance programs.
• Update registration pathways with financial assistance approval or denial information.
• Interpret managed care contracts and other third-party payer contacts to secure appropriate authorizations or referrals.
• Download and update the Dedicated Authorization log daily.
• Provide reports to management.

Benefits

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Paid time off (PTO)
• Career development and continuing education opportunities
• Health savings accounts
• Healthcare and dependent flexible spending accounts
• Employee Assistance Program
• Employee discount program
• Voluntary pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare, and auto and home insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED