Conifer Health Solutions
PSC Pre Authorization Rep - Remote
Conifer Health Solutions, Frisco, Texas, United States, 75034
PSC Pre Authorization Rep - Remote
at
Conifer Health Solutions
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
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)
Build and maintain 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
Minimum typing skills of 35 wpm
Demonstrated working knowledge of software/system/equipment
Knowledge of function and relationships within a hospital/physician office environment preferred
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
Knowledge of Medical Terminology preferred
Advanced understanding of third-party payer requirements preferred
Advanced understanding of healthcare compliance standards preferred
Ability to multi-task and manage time effectively
Education / Experience
High School Diploma or GED required
2-4 years experience in medical facility, health insurance, or related area
Some college coursework is preferred
Physical Demands
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
Work Environment
Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.
Other
Must be available to work hours and days as needed (including weekends and holidays) based on departmental/system demands
Resolves and as applicable escalates Physician’s office and client issues
May experience extreme case volumes and uncooperative parties
A part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that provides competitive benefits package and leadership to take your career to the next step!
Compensation
Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience.
Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
Conifer observed holidays receive time and a half.
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.
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Seniority level
Associate
Employment type
Full-time
Job function
Other
Industries
Hospitals and Health Care and Medical Practices
#J-18808-Ljbffr
at
Conifer Health Solutions
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
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)
Build and maintain 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
Minimum typing skills of 35 wpm
Demonstrated working knowledge of software/system/equipment
Knowledge of function and relationships within a hospital/physician office environment preferred
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
Knowledge of Medical Terminology preferred
Advanced understanding of third-party payer requirements preferred
Advanced understanding of healthcare compliance standards preferred
Ability to multi-task and manage time effectively
Education / Experience
High School Diploma or GED required
2-4 years experience in medical facility, health insurance, or related area
Some college coursework is preferred
Physical Demands
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
Work Environment
Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.
Other
Must be available to work hours and days as needed (including weekends and holidays) based on departmental/system demands
Resolves and as applicable escalates Physician’s office and client issues
May experience extreme case volumes and uncooperative parties
A part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that provides competitive benefits package and leadership to take your career to the next step!
Compensation
Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience.
Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
Conifer observed holidays receive time and a half.
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.
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Seniority level
Associate
Employment type
Full-time
Job function
Other
Industries
Hospitals and Health Care and Medical Practices
#J-18808-Ljbffr