PSC Pre Authorization Rep, Days

Conifer Health Solutions•Frisco, TX

52d•$16 - $24

About The Position

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. 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.

Requirements

Minimum typing skills of 35 wpm
Demonstrated working knowledge of software/system/equipment
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
Ability to multi-task and manage time effectively
High School Diploma or GED required
2-4 years experience in medical facility, health insurance, or related area
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
Must be available to work hours and days as needed (including weekends and holidays) based on departmental/system demands

Nice To Haves

Knowledge of function and relationships within a hospital / physician office environment preferred
Knowledge of Medical Terminology preferred
Advanced understanding of third-party payer requirements preferred
Advanced understanding of healthcare compliance standards preferred
Some college coursework is preferred

Responsibilities

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.
Resolves and as applicable escalates Physician’s office and client issues
May experience extreme case volumes and uncooperative parties

Benefits

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.

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