PSC Pre Auth Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist the clinical pre-authorization services team

• Confirm benefits and establish authorization requirements

• Obtain necessary authorizations for inpatient, outpatient, and emergency services

• Tackle complex issues that require clinical insights and/or escalation, such as peer-to-peer reviews and denials

• Foster and sustain collaborative relationships with both internal and external clients

• Engage with clients and revenue cycle personnel to streamline the authorization process

• Seek clarification on orders, verify clinical documentation, and follow up on outstanding requests

• Take part in quality control audit processes, departmental projects, and initiatives aimed at enhancing scorecard metrics

• Offer insights on workflow enhancement opportunities and assist in their successful implementation

• Address and, if necessary, escalate issues from physician offices and clients

• Operate in a call center setting using a desk, computer, telephone, printer, and other office equipment

• May encounter high case volumes and uncooperative parties

⛳️ Requirements

• High School Diploma or GED is mandatory

• 2-4 years of experience in a medical facility, health insurance, or a related field

• Minimum typing speed of 35 wpm

• Proven working knowledge of software, systems, and equipment

• Superior customer service skills and experience

• Capability to thrive in a fast-paced environment

• Competence in receiving and conveying detailed information through both oral and written communication

• Ability to juggle multiple tasks and manage time efficiently

• Must be willing to work hours and days as required, including weekends and holidays, depending on departmental/system needs

• Some college coursework is preferred

• Familiarity with functions and relationships within a hospital/physician office environment is a plus

• Knowledge of Medical Terminology is preferred

• Advanced understanding of third-party payer requirements is preferred

• Advanced grasp of healthcare compliance standards is preferred

• Must secure and provide documentation of required vaccinations and screenings, as applicable and permitted by law, before employment

• Must be able to remain seated at a computer terminal for extended durations

• Occasionally lift/carry items weighing up to 25 lbs.

• Frequent prolonged periods of sitting and walking

🏝️ Benefits

• Position may qualify for a signing bonus for eligible new hires, contingent on employment status.

• Conifer-recognized holidays receive time and a half pay.

• Medical, dental, vision, disability, and life insurance coverage

• Paid time off (vacation & sick leave) – a minimum of 12 days annually, accruing at approximately 1.84 hours per 40 hours worked.

• 401k plan with up to a 6% employer match

• 10 paid holidays each year

• Health savings accounts, along with 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 employees in Colorado, Conifer provides paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.