Prior Auth Representative Associate

Corewell Health • Kentwood, MI

3d • Hybrid

About The Position

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. 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.

Requirements

• High School Diploma or equivalent
• 1 year of relevant experience in related field

Nice To Haves

• Basic understanding of medical terminology
• Prior Authorization experience
• Epic experience
• Payor portal experience

Responsibilities

• 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 90% or higher audit score consistently and be receptive to constructive feedback.
• Proficient in one primary service area with a firm understanding of the industry standard authorization requirements.
• Able to obtain 15 authorizations daily (consideration for type of service line)

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• 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
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

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