PSC Pre Auth Representative - Remote

Conifer Health Solutions, LLC.; Frisco (TX); On-site; USD 22,000 - 33,000; Full time

Benefits offered by this job

Medical, dental, vision

401k with match

Paid time off (min 12 days/yr)

Job summary

Conifer Health Solutions, LLC. is seeking a Patient Service Center (PSC) support specialist in Frisco, TX to help ensure departmental efficiencies in benefits verification, authorization gathering, and submission.

You will work with PSC leaders to support operational and quality excellence and use multiple electronic tools required by Conifer and its clients. The role emphasizes accuracy in benefit verification, timely authorizations, and escalation of clinical issues while maintaining strong

Qualifications

• High School Diploma or GED required.
• 2-4 years experience in medical facility, health insurance, or related area.
• Some college coursework is preferred.

Responsibilities

• 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).
• Interact with clients and revenue cycle staff to facilitate the authorization process and follow up on pending requests.
• Participate in quality control audit processes to improve scorecard metrics and suggest workflow improvements.

Education

High School Diploma or GED

Job description

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)
• 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.

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.

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

As 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 gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

• 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.

Conifer offers the following benefits, subject to employment status:

• 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 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.

Employment practices will not be influenced or affected by an applicant'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.

$15.80 - $23.70 hourly **Individual wages are determined based upon a number of factors including, but not limited to, an individual's qualifications and experience