PSC Pre Auth Rep- Remote

About the position 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.

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)
• 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.

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

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

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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