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Authorization Representative Days FT
Children’s Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI. The Children’s Hospital of Michigan Emergency Department is a verified Level 1 Pediatric Trauma Center and dedicated pediatric burn center. Experts in pediatric critical care, rehabilitation, and neonatal and perinatal medicine provide care for thousands of children every year at Children’s Hospital of Michigan, Children’s Hospital of Michigan - Troy and six ambulatory sites.
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.
1. High School diploma or equivalent. Associate degree in finance or business administration highly desirable.
2. Four or more years of prior work experience in patient registration, patient accounting and knowledge of third party payors.
3. Familiarity with medical terminology and concepts.
4. Working knowledge with third party insurance verification, respective systems, authorization, referral procedures and clinical care process internal and external.
5.Comprehensive knowledge of patient access process. 6. Working knowledge of Michigan based Managed Care programs.
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.
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