Prior Authorization Representative

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. Staff will be trained in various clinical service lines with the ability to support multiple areas within the Central Authorization team. 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 afterwards based on satisfactory progress including authorizations obtained daily and a passing audit score.

• 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 manner 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 95% or higher audit score consistently and be open to constructive feedback.
• Proficient in two clinical service areas navigating the nuances of those area’s authorization requirements.
• Able to obtain 20 authorizations daily (consideration for type of service line).

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

• Basic understanding of medical terminology
• Payor Portal Experience
• Epic Experience
• 1 year of relevant experience Revenue Cycle

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.

• 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

SITE – Kentwood Medical Office Building – 4600 Breton Rd SE – Kentwood

Department Name:
Contact Center Pre Authorizations – Corporate

Employment Type:

Full time

Shift: Day (United States of America)

Weekly Scheduled

Hours:

40

Hours of Work: 8 a.m. to 4:30 p.m.

Days Worked:
Monday to Friday

Weekend Frequency: N/A

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…