Prior Authorization Representative Associate

Corewell Health; Kentwood (MI); Hybrid; USD 42,000 - 65,000; Full time

Benefits offered by this job

On-demand pay program

Discounts directory with deals

Identity theft protection

Retirement options with matching

Comprehensive benefits package

Job summary

Corewell Health in Grand Rapids, MI is seeking a Pre Authorizations clerk to support the Financial Clearance process. The role includes training on-site for six weeks, then remote work, and requires living within an hour of Grand Rapids for potential in-person duties.

Responsibilities include using payer websites, verifying benefits and authorization requirements, and obtaining authorizations while maintaining quality.

Qualifications

• High School Diploma or equivalent required; 1 year of related experience.
• Preferred: Epic experience and payor portal experience.
• Basic understanding of medical terminology.

Responsibilities

• Utilize payer websites and maintain up-to-date credentials for COB and authorization requirements.
• Perform chart abstraction to pull clinical data for payer review.
• Adhere to department procedures and use resources appropriately.
• Complete authorization requests in a timely manner without compromising quality.
• Communicate barriers to prevent patient delays and show critical thinking.
• Maintain a 90% or higher audit score and respond to feedback.

Skills

Attention to detail

Communication skills

Time management

Education

High School Diploma or equivalent

Tools

Epic experience

Payor portal experience

Job description

Job Summary

This role will have up to a week of in person training in Grand Rapids, MI but then move to work from home after that. Must live within an hour of the GR in case of any in person work. 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. 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 after that time pursuant on satisfactory progress including authorizations obtained daily and a passing audit score.

Essential Functions

• 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 manor 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 90% or higher audit score consistently and be receptive to constructive feedback.
• Proficient in one primary service area with a firm understanding of the industry standard authorization requirements.
• Able to obtain 15 authorizations daily (consideration for type of service line)

Qualifications

Required

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

Preferred

• Basic understanding of medical terminology
• Prior Authorization experience
• Epic experience
• Payor portal experience

About Corewell Health

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.

How Corewell Health cares for you

• 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
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Care Center Breton - 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

8:30 a.m. to 5:00 p.m.

Days Worked

Monday - 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 information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.