Prior Authorization Representative

About the role

Provides clerical support to assist in the delivery of quality healthcare services via a Financial Clearance model by obtaining accurate and timely authorizations. Staff will be trained in various clinical service lines to support multiple areas within the Central Authorization team. Crucial to obtaining an authorization is the ability to read and understand basic insurance information and perform a complete and accurate registration. Training consists of six weeks of in-person instruction, shifting to remote training after satisfactory progress (including daily authorizations obtained and a passing audit score).

Primary Location: SITE - Care Center Breton, 4600 Breton Rd SE, Kentwood. Department: Contact Center Pre Authorizations - Corporate. Employment Type: Full time.

Responsibilities

• Utilize all payer websites and maintain up-to-date credentials to verify patient coordination of benefits and authorization requirements.
• Perform chart abstraction to pull clinical data from a patient’s chart for review by a payer’s clinical team.
• Adhere to department procedures, guidelines, and standard work, utilizing resources appropriately.
• Complete authorization requests in a timely and efficient manner without compromising quality to ensure patients receive care as scheduled.
• Communicate barriers effectively to avoid patient delays in care, demonstrating critical thinking to anticipate and resolve barriers.
• Maintain a 95% or higher audit score consistently and be open to constructive feedback.
• Be proficient in two clinical service areas, navigating the nuances of those areas’ authorization requirements.
• Obtain approximately 20 authorizations daily (consideration for type of service line).

Qualifications

• Required: High School Diploma or equivalent.
• Required: 1 year of relevant experience in a related field.
• Required: 1 year of relevant experience in Prior Authorizations.
• Preferred: 1 year of relevant experience in Revenue Cycle.
• Preferred: Epic Experience.
• Preferred: Payor Portal Experience.
• Preferred: Basic understanding of medical terminology.

Skills

• Ability to utilize payer websites and maintain credentials.
• Chart abstraction and clinical data extraction.
• Adherence to procedures and standard work.
• Tim