Authorization Representative - Oncology

Tenet Healthcare; Commerce (CA); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

401(k) with employer match

Generous PTO

Career development

Health savings accounts

Employee Assistance program

Pet insurance

Legal insurance

Job summary

Tenet Healthcare Corporation in Commerce Township, MI seeks a Patient Access/Admitting professional to secure authorizations and referrals throughout the patient stay. You will verify insurance data, update registration details in SMS, and coordinate with eligibility vendors to support timely payments.

Responsibilities include obtaining financial approvals for internal assistance programs, interpreting Managed Care contracts, and generating management reports.

Qualifications

• High School diploma or equivalent is required.
• 4+ years in patient registration/accounting with exposure to third party payors.
• Familiarity with medical terminology and concepts.
• Knowledge of third party verification, authorization, referral procedures and care processes.
• Understanding of patient access processes and Michigan Managed Care programs.
• Proficiency with computers, databases and spreadsheets.

Responsibilities

• Secure and track authorizations/referrals through patient stays or visits.
• Ensure authorizations/referrals and re-authorizations are obtained and secured.
• Verify insurance information and maintain SMS registration accuracy.
• Generate reports for management and coordinate with eligibility vendors.
• Understand Managed Care contracts and payer contacts to secure correct authorizations.
• Update logs daily and communicate approval/denial information.

Skills

Third party payor requirements

Customer service orientation

Verbal communication

Team collaboration

Multitasking and organization

Policy interpretation and diplomacy

Computer literacy and spreadsheets

Education

High School diploma or equivalent

Associate degree in finance or business administration

Tools

SMS registration pathways

Job description

Embark on a rewarding career with DMC Huron Valley-Sinai Hospital. If you are a compassionate healthcare professional eager to contribute to patient care, this is your opportunity where your skills make a difference every day. Join us in delivering exceptional healthcare with a personal touch.

Benefits Statement

At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• Career development and continuing education opportunities
• 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, auto & home insurance.

Note: Eligibility for benefits may vary by location and is determined by employment status

Job Summary

Under general supervision is responsible for securing and tracking authorizations/referrals through patient's length of stay or visit. Assures authorizations/referrals and re-authorizations are obtained and secured for hospital and clinic patients. Participates in the care and customer service process by ensuring all authorizations have been received. Assures appropriate verified insurance information has been updated in SMS registration pathways to ensure timely payment and to meet clean claim requirements. Coordinates with outside eligibility vendor and Clinical Resource Management as necessary using established criteria. Obtains financial approvals and supporting documentation for internal financial assistance programs, updates the registration pathways with approval or denial information. Interprets Managed Care contracts and other third party payer contacts in order to secure correct authorization and/or referral. Downloads and updates Dedicated Authorization log on a daily basis. Provides various reports to management.

Qualifications

• High School diploma or equivalent. Associate degree in finance or business administration highly desirable.
• Four or more years of prior work experience in patient registration, patient accounting and knowledge of third party payors.
• Familiarity with medical terminology and concepts.
• Working knowledge with third party insurance verification, respective systems, authorization, referral procedures and clinical care process internal and external.
• Comprehensive knowledge of patient access process.
• Working knowledge of Michigan based Managed Care programs.

Skills Required

• Ability to understand and apply various third party payor requirements, verifications procedures and insurance benefit knowledge.
• Strong customer service orientation skills necessary to deal effectively with various levels of hospital staff, to communicate with diverse populations, and to relay sensitive and confidential information to patients, internal staff and a variety of external organizations.
• Excellent verbal and people skills; strong face-to-face communicator.
• Ability to work as a team with clinical staff as well as business office and payer staff.
• Ability to manage multiple tasks and organize appropriately.
• Analytical skills necessary to calculate patient liability, income status and solve problems related to credit and collection matters.
• Communication and/or interpersonal skills for contact with internal and external customers/stakeholders to discuss and interpret technical information and department or function policy. Some discretion must be exercised in deciding what and how to communicate. Conflict resolution skills are exercised within the unit or function and occasionally on an interdepartmental or interfunctional basis. Diplomacy, tact and listening skills are required.
• Ability to read and comprehend policies and interpret technical materials in the specialty area is necessary.
• Proficient in the use of computers, database programs and a variety of computer spreadsheet programs.

Facility Description

DMC Huron Valley-Sinai Hospital in Oakland County is committed to outstanding customer service and medical care. This hospital features the Harris Birthing Center with all private birthing suites, the Charach Cancer Treatment Center (affiliated with the Barbara Ann Karmanos Cancer Center), cardiac services, and comprehensive inpatient and outpatient diagnostic care. For emergency services, obstetrics and ambulatory surgery, Huron Valley-Sinai consistently ranks among the top hospitals in the nation.

EEO Statement

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.

Tenet participates in the E-Verify program. Follow the link below for additional information.

E-Verify: http://www.uscis.gov/e-verify

The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.

Job: Patient Access/Admitting

Primary Location: Commerce Township, Michigan

Facility: DMC Huron Valley-Sinai Hospital

Job Type: Full Time

Shift Type: Day

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.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: http://www.uscis.gov/e-verify
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.